1. Assessment and Case Management in New York Dr. Barry T. Hawkins, Ph.D. Director of Chemical Dependency Services, Orange County, New York

2. “Assessment” is used to mean several things, including: Medical examination Behavioral Screening Level of Need Assessment Comprehensive Evaluation

3. Screening Brief behavioral “assessment” that indicates probability of a problem, suggesting initial action. CAGE AUDIT ASSIST MSSI

4. The CAGE Four Questions Highly rated Can include other drugs “CAGE-AID” http://counsellingresource.com/quizze s/alcohol-cage/index.html

5. The “AUDIT” http://whqlibdoc.who.int/hq/2001/who_ msd_msb_01.6a.pdf 10 Questions Developed by WHO Validated with Korean students.

6. The “ASSIST” www.who.int/substance_abuse/activiti es/assist/en/index.html Lengthier – up to 70 questions Seven questions on each substance.

7. The MSSI 16 Items Highly rated Includes prescription and over-the- counter drug use. http://www.nyc.gov/html/doh/html/qi/qi _samhpriority.shtml Available in Korean

8. Assessment Primarily functional assessment that usually takes place in Social Services Offices or at application to admission. Consists of 1-2 meetings and indicates probable level of care determination. ASAM New York “LOCADTR”

12. Comprehensive Evaluation Bio-Psycho-Social Evaluation including but not limited to the patient's history of alcohol and/or substance use, medical history, mental status, educational, vocational, and employment status and history, legal status, and living arrangement.

13. Mental Status: Appearance Thought Content Speech Form of Thought Mood Perceptions Affect Orientation Insight and judgement

14. Alcohol & Substance history Age of onset Method and Frequency Amount Date of last use Symptomology

15. Other domains: Social- Leisure – explores social interaction, positive time use, isolating behaviours Activities of Daily Living – personal hygiene, money management, nutrition, use of transportation Education/ Vocation – level of school completed, skills, work history, LD’s

16. Other domains continued: Employment – work history, aspirations, etc. Family – relationships with primary family, spouse, children, domestic violence. Legal – past and present legal involvements, outstanding issues Medical/Health – including medications, diet, dental, etc.

17. Other domains continued: Communicable Disease Risk Assessment – Tuberculosis, Hepatitis, STD’s Mental/ Emotional Health – danger to self or others, hospitalizations, psychotropic meds. Results of screening instrument (Mini). Axis I and II Diagnoses.

18. Stages of Change: Pre-contemplation Contemplation Preparation Action Maintenance Relapse

19. Strengths Challenges Motivation Intelligence Ability to self-reflect Openness to change Friendly Strong support network Impaired self- regulation Socially isolated or guarded Denial Treatment resistant Unmotivated Limited supports

20. Other areas that may be assessed: Problem Gambling Assessment Tobacco/nicotine Assessment Trauma history

21. “Case Management” is used in at least two senses: Treatment Planning and Implementation Care Coordination/facilitation

22. Treatment Planning: Goals and objectives in functional areas Medical/Physical Health Alcohol/Chemical use, dependence Mental/Emotional Health Vocational-Educational Family – Significant Other Legal involvement Activities of Daily Living Tobacco & Gambling

23. Types of activities in treatment settings: Group Treatment Skills Development Interpersonal Process Psycho-educational Specialized Individual Treatment Individual Counseling

24. Examples of Groups Anger management Recovery Orientation Gender specific Assertiveness Psycho-drama Relapse prevention Relaxation/meditation

25. Other Treatment Activities: Acupuncture Nutritional counseling Art therapy Therapeutic recreation Introduction to Self Help Health & Wellness Family counseling

26. Support services Self-help groups (12 Step and others) Religious resources Other services

29. Some aims of various activities: Socialization Develop coping skills Identify negative “triggers” Education Learn to express feelings Link to support systems/resources Create relapse prevention plan Replace negative with positive behaviors Increase self esteem

30. Case Management as Care Coordination: Generally, clients have multiple issues that must be addressed in order to create an environment that allows for recovery. Habitation – permanent safe housing Economic – employment or subsidized living and health benefits Social – friends and family that support recovery. Health – in addition to primary issue, full adoption of wellness strategies

31. The Whole Person Recovers Without attention to all areas, success in one area may be sabotaged by failure in another.

32. Functions of the Case Manager: Monitoring Advocacy Motivation Ongoing Assessment Crisis Intervention Support Creative Problem solving Brokering services

33. “Greetings to the Support Committee and participants in the Korean National Alcohol Project. We are happy to hear about your fine efforts to address the problems facing so many of our people. We are glad that we can partner with you and offer some small consultation as you continue to develop and refine your work. Best wishes in this important effort.” …Arlene González-Sánchez, Commissioner, New York State Office of Alcoholism and Substance Abuse Services From New York State

34. From the County of Orange Greetings from the Orange County, New York, Department of Mental Health. We are pleased to participate in this conference in collaboration with the Korean National Alcohol Project. We’ve been working in this field for many, many years and know the importance of your commitment to the persons you serve.” …Chris Ashman, Commissioner, Orange County Department of Mental Health

35. QUESTIONS?

36. Supplementary Slides

37. Common C.M. Values Most in need served first Recovery focus Minimize coerced treatment Consumer choice Community Integration Flexibility Cost effectiveness

38. Stages of Change – Prochaska, DiClemente

39. CHANGING HOW WE SEE CHANGE CHANGE IS A PROCESS NOT A SINGLE EVENT CHANGE IS OFTEN ACCOMPANIED BY BEHAVIORAL REVIEW (RELAPSE) EACH STAGE PREPARES FOR THE NEXT, AND IS HELPFUL ACTION IS OFTEN LATE IN THE PROCESS RELAPSE IS A NATURAL PART OF THE PROCESS

42. Some CASAC References NYS CASAC Credential Application Packet. New York State Office of Alcoholism and Substance Abuse Services, 2010 NYS OASAS Website www.oasas.state.ny.us www.oasas.state.ny.us Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice U.S. Center for Substance Abuse Treatment Technical Assistance Publication # 21, 1998

43. Some Assessment and Case Management References US Substance Abuse and Mental Health Services Administration Treatment Improvement Protocol Series. http://www.samhsa.gov / http://www.samhsa.gov / Northeast Addiction Technology Transfer Center. – http://www.nattc.org/index.asp