In SAVVY, SKILLS and STUMP THE SHRINK, treatment providers can be confused about their role when clients are referred by Probation, Child Protective Services and other mandating agencies. Focus on improved function and skills, not compliance with assignments and phases in a pre-determined program. How to be “client-centered”.
In SOUL, increasingly I make no distinction between ‘wins’ and ‘losses’. A ‘win’ is an opportunity to discern what works and what doesn’t; and a ‘loss’ is an opportunity to discern what works and doesn’t.
When clients are referred for treatment by Probation and Parole or Child Protective Services, very few, if any, want to embrace recovery from Day 1. Their usual perspective is to do the minimum possible to comply with the mandating agency and get what they want: to get off probation supervision and/or get their children back.
Treatment providers can easily become confused about their role:
In this context, the following STUMP THE SHRINK question addresses the dilemma about what to report to mandating agencies.
Question:
I have a question about working with clients who are sent to us by Probation Officers or Child Protective Services (CPS). We have had a very difficult time with communication. They want us to provide all information and we typically just provide a letter that states attendance and treatment recommendations. CPS especially has wanted us to provide everything, including assessments and lately has been wanting us to drug test their clients on their behalf which is not great. Is there a standard best practice in situations like this?
Thanks,
Executive Director, Behavioral Health Services.
Iowa
Tip 1
Focus on improved function and skills, not compliance with assignments and phases in a pre-determined program.
My Response:
Here are my thoughts on communicating with mandating agencies:
I have written much more on treatment and functional change; sanctions and incentives in the March 2016 edition of Tips and Topics
In the July 2017 edition, Tip #2, Question 2, I suggested how to balance confidentiality concerns with what to report about the client. (Sorry, the formatting of this older edition needs some work. So finding Tip #2, Question 2 might be like finding Waldo. But worth the search.)
As regards drug testing, that is something you should be doing clinically just as you would test a patient’s blood sugar levels in managing a person with diabetes; or blood levels of medication in monitoring effectiveness of treatments with schizophrenia or bipolar disorder etc. Drug testing is a lab test that helps monitor a person’s ability to control substance use, not just taking their word for it.
See previous editions of Tips and Topics for more on:
Tip 2
What Treatment Courts and other Mandating Agencies Should Expect from Treatment Providers
Participants mandated to treatment are varied and can present with addiction, mental health and physical health complexity. These diverse clinical presentations highlight the need for individualized approaches that treatment providers should be pursuing with the client:
(a) Assessment of each client’s multidimensional needs as per The ASAM Criteria six dimensions*. For example, assessing if a person is developmentally disabled and suffers from an intellectual developmental disorder (previously called Mental Retardation) is important compared with a person who has antisocial personality disorder or lifestyle and is very institutionalized and used to incarceration.
* 1. Acute intoxication and/or withdrawal potential
2. Biomedical conditions and complications
3. Emotional/behavioral/cognitive conditions and complications
4. Readiness to Change
5. Relapse/Continued Use/Continued Problem potential
6. Recovery environment
(b) Assessment and methods to enhance treatment engagement and good faith effort of the client in treatment. For example, participants with co-occurring mental and addiction issues will have more difficulty with engagement and have needs that require awareness of their multiple vulnerabilities.
(c) Outcomes-driven treatment. Is the client making progress in real accountable change?
Tip 3
Client-centered treatment doesn’t mean passively allowing clients to do whatever they want.
A Treatment Court Coordinator shared her frustration with me over Treatment Providers who have good intentions to implement “client-centered” treatment. However, their interpretation of “client-centered” services means to allow clients to make their own decisions without therapeutic challenge and accountability for the outcomes of their choices.
For example, a well-intended but ineffective treatment strategy:
More effective client-centered approach:
In the good old days BC (Before COVID), I attended a number of addiction treatment conferences held in Las Vegas casino hotels. That always seemed quite ironic to me, to hold an addiction conference with many attendees in short and long-term recovery needing to walk through halls with hundreds of people drinking, smoking and gambling.
It did however, give me a chance to try my hand at Lady Luck. Being the sophisticated gambler that I am, I sometimes wagered $10 on the penny slots. I have even splurged $20 on the 5 cent or can you believe it, the 25 cent slots. A few times I lost the whole $10 or $20. But most times I learned from my experience and had the gumption to cash out happily with my $1.95 winnings before I lost my whole spending money.
Others who suffer from addiction manifested as Gambling Disorder, are not wired to walk away and can end up losing fortunes, family and friends as they chase the losses and compulsively wager their life away. By the way, March is Problem Gambling Awareness Month.
Increasingly now I make no distinction between ‘wins’ and ‘losses’. Unless you have Gambling Disorder that needs specific addiction attention, a ‘win’ is an opportunity to discern what works and what doesn’t; and a ‘loss’ is an opportunity to discern what works and doesn’t.
For example, my daughter’s family has been trying to buy a home in a still competitive real estate market. They recently found a house they wanted to bid on, but lost out to one of the ten bidders. The next house they lost to someone else even before they had a chance to put in a formal bid. The third house they wanted, they were ready to capitalize on what they had learned from two failed bids….and they won. Not only did they get their offer accepted but it was for a house in a more desirable location with a better layout than the first two targets.
Their first two losses resulted in a better ‘win’ than what they could have planned for.
Like they say, “you win some, you lose some”. It’s just that in my book, you always win.