An interview with a counseling professional on the use of assessments

For a class assignment in Assessment Technique in Clinical Mental Health Counseling at University of San Diego.

Within the counseling profession, there are a variety of clinical settings and various levels of clinical competency that affect decisions regarding the use assessment tools. I had a recent conversation with the program director of an outpatient alcohol and drug treatment program within a community medical clinic setting to find out what assessments they use. Through our conversation, I learned a great deal about how substance abuse counselors use various types of assessments in their work.

The program director operates several different programs for his agency, most of which are funded by federal and state programs through contracts with the County of San Diego. Accordingly, there are numerous federal, state, and local regulations, guidelines, and company policies that must be followed. The clinic that I visited offers a wide range of health services from primary medical care to outpatient substance use recovery to disease prevention. The clientele includes many mandated individuals who are court-ordered under the California Substance Abuse and Crime Prevention Act of 2000 (known as Prop 36) to receive treatment and substance abuse recovery services are part of their criminal sentence. Because the community clinic’s mission is to provide cost-effective medical care with a special commitment to those who are medically underserved, most program participants are unemployed and uninsured or under insured. Many have co-occurring disorders and receive separate mental health services through other agencies or departments. Because this agency is known as a leading provider of HIV-related services, a significant number of the clientele are members of the LGBTQ community. When clients participate in other agency programs, their medical charts or counseling files are not shared with others outside of the Alcohol and Drug Services Department to comply with privacy regulation including the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Similarly, staff in the program I visited do not usually access records or charts from other providers with mutual clients because the clients’ anonymity.

The program is divided into three phases and normally spans a period of 6 weeks to three months, to be flexible in meeting client’s needs and program requirements. Clients are mostly drug offenders convicted of nonviolent crimes; completing this program is designed to efficiently rehabilitate the clients and avoid further criminal involvement and relapse with substance use. To this end, clients are expected to participate in a 12-Step program which includes regular attendance at recovery meetings, meeting with a sponsor, personal reflection, and ongoing psychoeducational presentations about the harmful effects of substance use and addiction. Clients may select groups based on Narcotics Anonymous or SMART Recovery.

Intakes are conducted weekly on Tuesday mornings; often group intakes are conducted whenever more there is more than one client in a given week. Clients complete a 4-page intake to on their own in either English or Spanish; if help is needed, the receptionist provides limited assistance. The form is fairly generic, asking essentially the same basic questions as on the examples we reviewed in class. Once the intake data is collected, a substance abuse counselor facilitates a group orientation where the appropriate informed consent and release of information forms are explained and signed. Counselors review program expectations and explain the co-payment structure. The agency accepts a sliding scale for services. Even clients who are homeless with no source of income are asked to contribute something towards their treatment.

Following the group orientation, clients meet one on one with the substance abuse counselors where a more thorough assessment of the client’s substance abuse history and needs for recovery as completed. County of San Diego requirements proscribe use of the Addiction Severity Index (ASI - Lite) with all clients. The purpose of the ASI is to determine how best to determine treatment to meet client needs as well as provide data for outcome efficacy. The substance abuse counselors also rely on the Transtheoretical Model for the Stages of Change and employ Motivational Interviewing techniques. Most of the substance abuse counselors are in recovery themselves and have been through NA or AA in their personal history. Agency requirements specify that any applicants for this position who have a substance use history be in recovery for a minimum of three years to qualify for this position.  

When asked about the idea of designing better assessment for use in this setting, the program director thought for a moment and then stated that the chief weakness of the assessment tools they currently use rely too heavily on self-report measures. Because alcohol and drug addicts, perhaps notoriously, develop behavior patterns that are manipulative or untruthful to hide their addictions, it takes a highly skilled counselor to evaluate clients successfully. “Too bad we can’t administer a polygraph,” he quipped.

Substance use workers are familiar with the ACA code of ethics but are most likely to employ the Uniform Code of Conduct of the California Certified Alcohol and Other Drug Counselors. The program director reports no major areas of ethical concern regarding their use of assessments, but did state that the state places moratoria on training for new staff due to the cyclical budget crisis. This creates a dearth of qualified staff for his program which constrains his ability meet the demand of his services efficiently.