Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice
Technical Assistance Publication (TAP) Series 21

Section 1: Transdisciplinary Foundations

Introduction to the Transdisciplinary Foundations

     Addictions professionals work in a broad variety of disciplines but share an understanding of the addictive process that goes beyond the narrow confines of any one specialty. Specific proficiencies, skills, levels of involvement with clients, and scope of practice do vary widely among specializations. At their base, however, all addiction-focused disciplines are built on a common foundation.

     This section focuses on a set of competencies that are transdisciplinary in that they underlie the work not just of counselors but of all addictions professionals. The areas of knowledge identified here serve as prerequisites to the development of competency in any of the practice specialties. These foundations include:

Regardless of professional identity or discipline, each treatment provider must have a basic understanding of addiction that includes knowledge of current models and theories, appreciation of the multiple contexts within which substance use occurs, and awareness of the effects of psychoactive drug use. Each professional must be knowledgeable about the continuum of care and the social contexts affecting the treatment and recovery process. Each addictions specialist must be able to identify a variety of helping strategies that can be tailored to meet the needs of the individual client. Each professional must be prepared to adapt to an ever-changing set of challenges and constraints.

     Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective practice in addictions depends on the presence of attitudes reflecting openness to alternative approaches, appreciation of diversity, and willingness to change.

I. TRANSDISCIPLINARY FOUNDATIONS

The following knowledge and attitudes are prerequisite to the development of competency in the professional treatment of substance use disorders. Such knowledge and attitudes form the basis of understanding upon which discipline-specific proficiencies are built.



            1. Stages of change and readiness for treatment.
            2. The treatment planning process.
            3. Motivation and motivating factors.
            4. The role and importance of client resources and barriers to treatment.
            5. The impact that the client and family systems have on treatment decisions and outcomes.
            6. Other sources of assessment information.
            1. Establishing treatment priorities based on all available data.
            2. Working with clients of different age, developmental levels, gender, racial, and ethnic cultures.
            3. Interpreting data.

            Attitudes

            1. Appreciation of the strengths and limitations of the client and significant others.
            2. Recognition of the value of thoroughness and follow-through.

            2. Explain assessment findings to the client and significant others involved in potential treatment.

            Knowledge

            1. How to apply confidentiality regulations.
            2. Effective communication styles.
            3. Factors effecting the client’s comprehension of assessment findings.
            4. Roles and expectations of others potentially involved in treatment.

            Skills

            1. Translating assessment information into treatment goal and outcomes.
            2. Summarizing and synthesizing assessment results.
            3. Assessing client for understanding and correcting misunderstandings.
            4. Communicating with clients in a manner that is sensitive to cultural and gender issues.
            5. Communicating assessment findings to interested parties within the bounds of confidentiality regulations and practice standards.

            Attitudes

            1. Recognition of one’s own treatment biases.
            2. Willingness to consider multiple approaches to recovery and change.
            3. Recognition of the client’s right and need to understand assessment results.
            4. Respect for the roles of others.

            3. Provide the client and significant others with clarification and further information as needed.

            Knowledge

            1. Effective communication styles.
            2. Methods to elicit feedback.

            Skills

            1. Eliciting feedback.
            2. Working collaboratively.
            3. Establishing trusting relationship.

            Attitudes

            1. Willingness to communicate interactively with the client and significant others.

            4. Examine treatment implications in collaboration with the client and significant others.

            Knowledge

            1. Available treatment modalities, client placement criteria, and cost issues.
            2. The effectiveness of the various treatment models based on current research.
            3. Implications of various treatment alternatives, including no treatment.

            Skills

            1. Synthesizing available data to establish treatment priorities.
            2. Explaining the treatment process.
            3. Presenting information in a non-judgmental manner.
            4. Selecting treatment settings appropriate for client needs and preferences.
            5. Building partnerships with client and significant others.

            Attitudes

            1. Willingness to negotiate with the client.
            2. Open-mindedness toward a variety of approaches.
            3. Respect for input from client and significant others.

            5. Confirm the readiness of the client and significant others to participate in treatment.

            Knowledge

            1. Motivational processes.
            2. Stages of change models.

            Skills

            1. Assessing and developing strategies to overcome barriers.
            2. Eliciting the client’s preferences for treatment.
            3. Promoting the client's readiness to accept treatment.

            Attitudes

            1. Respect for client values and goals.
            2. Patience and perseverance.

            6. Prioritize client needs in the order they will be addressed.

            Knowledge

            1. Treatment sequencing and the continuum of care.
            2. Hierarchy of needs.
            3. Interrelationship among client needs and problems.

            Skills

            1. Timing.
            2. Sequencing.
            3. Prioritizing.

            Attitudes

            1. Sensitivity to the client’s needs and perceptions.

            7. Formulate mutually agreed upon and measurable treatment outcome statements for each need.

            Knowledge

            1. Levels of client motivation.
            2. Treatment needs of diverse populations.
            3. How to write measurable outcome statements.

            Skills

            1. Translating assessment information into measurable treatment goals and outcome statements.
            2. Working with the client to develop realistic time frames for completing goals.
            3. Engaging, contracting, and negotiating with the client.

            Attitudes

            1. Respect for the client’s treatment and life goals.
            2. Respect for the client’s individual pace toward change.
            3. Appreciation for incremental treatment goals and achievements.

            8. Identify appropriate strategies for each outcome.

            Knowledge

            1. Intervention strategies.
            2. Level of client’s interest in making specific changes.
            3. Treatment issues with diverse populations.

            Skills

            1. Identifying alternate approaches tailored to client needs.
            2. Implementing strategies in terms understandable to the client.

            Attitudes

            1. Respect for client and others.
            2. Appreciation for various treatment strategies.

            9. Coordinate treatment activities and community resources with prioritized client needs in a manner consistent with the client's diagnosis and existing placement criteria.

            Knowledge

            1. Treatment modalities and community resources.
            2. Contributions of other professions and mutual-help or self-help support groups.
            3. Current placement criteria.
            4. The importance of client’s racial or ethnic culture, age, developmental level, gender, and life circumstances in coordinating resources to client needs.

            Skills

            1. Coordinating resources and solutions with client needs, desires, and preferences.
            2. Explaining the rationale behind treatment recommendations.
            3. Summarizing mutually agreed upon recommendations.

            Attitudes

            1. Acceptance of a variety of treatment approaches.
            2. Recognition of the importance of coordinating treatment activities.

            10. Develop with the client a mutually acceptable plan of action and method for monitoring and evaluating progress.

            Knowledge

            1. The relationship among problem statements, desired outcomes, and treatment strategies.
            2. Short- and long-term treatment planning.
            3. Evaluation methodology.

            Skills

            1. Individualizing treatment plans that balance strengths and resources with problems and deficits.
            2. Negotiating.
            3. Collaborating and contracting with the client in developing an action plan in positive, proactive terms.
            4. Establishing criteria to evaluate progress.

            Attitudes

            1. Sensitivity to gender and cultural issues.
            2. Recognition of the value of monitoring outcome.
            3. Willingness to negotiate.

            11. Inform client of confidentiality rights, program procedures that safeguard them, and the exceptions imposed by regulations.

            Knowledge

            1. Federal, State, and agency confidentiality regulations, requirements, and policies.
            2. Resources for legal consultation.
            3. Effective communication styles.

       

            Skills

            1. Communicating the roles of various interested parties and support systems.
            2. Explaining client rights and responsibilities and applicable regulations regarding confidentiality.
            3. Responding to questions and providing clarification as needed.
            4. Referring to appropriate legal authority.

            Attitudes

            1. Respect for client confidentiality rights.
            2. Commitment to professionalism.
            3. Recognition of the importance of professional collaboration within the bounds of confidentiality.

            12. Reassess the treatment plan at regular intervals and/or when indicated by changing circumstances.

            Knowledge

            1. How to evaluate treatment and stages of recovery.
            2. When and how to review and revise the treatment plan.

            Skills

            1. Modifying the treatment plan based on review of client progress and/or changing circumstances.
            2. Problem solving.
            3. Engaging, negotiating, and contracting.
            4. Eliciting client feedback on treatment experiences.

            Attitudes

            1. Recognition of the value of client input into treatment goals and process.
            2. Openness when critically examining one’s own work.
            3. Receptivity to client feedback.
            4. Willingness to learn from clinical supervision and modify practice appropriately.

      III. REFERRAL

      The process of facilitating the client’s utilization of available support systems and community resources to meet needs identified in clinical evaluation and/or treatment planning.

            1. Establish and maintain relations with civic groups, agencies, other professionals, governmental entities, and the community-at-large to ensure appropriate referrals, identify service gaps, expand community resources, and help to address unmet needs.

            Knowledge

            1. The mission, function, resources, and quality of services offered by such entities as the following: - civic groups, community groups, and neighborhood organizations; - religious organizations; - governmental entities; - health and allied health care systems (managed care); - criminal justice systems; - housing administrations; - employment and vocational rehabilitation services; - child care facilities; - crisis intervention programs; - abused persons programs; - mutual and self-help groups; - cultural enhancement organizations; - advocacy groups; - other agencies.
            2. Community demographics.
            3. The community’s political and cultural systems.
            4. Criteria for receiving community services, including fee and funding structures.
            5. How to access community agencies and service providers.
            6. State and Federal legislative mandates and regulations.
            7. Confidentiality regulations.
            8. Service gaps and appropriate ways of advocating for new resources.
            9. Effective communication styles.

            Skills

            1. Networking and communication.
            2. Using existing community resource directories including computer databases.
            3. Advocating for clients.
            4. Working with others as part of a team.

            Attitudes

            1. Respect for interdisciplinary service delivery.
            2. Respect for both client needs and agency services.
            3. Respect for collaboration and cooperation.
            4. Patience and perseverance.

            2. Continuously assess and evaluate referral resources to determine their appropriateness.

            Knowledge

            1. The needs of the client population served.
            2. How to access current information on the function, mission, and resources of community service providers.
            3. How to access current information on referral criteria and accreditation status of community service providers.
            4. How to access client satisfaction data regarding community service providers.

            Skills

            1. Establishing and nurturing collaborative relationships with key contacts in community service organizations.
            2. Interpreting and using evaluation and client feedback data.
            3. Giving feedback to community resources regarding their service delivery.

            Attitudes

            1. Respect for confidentiality regulations.
            2. Willingness to advocate on behalf of the client.

            3. Differentiate between situations in which it is most appropriate for the client to self-refer to a resource and instances requiring counselor referral.

            Knowledge

            1. Client motivation and ability to initiate and follow through with referrals.
            2. Factors in determining the optimal time to engage client in referral process.
            3. Clinical assessment methods.
            4. Empowerment techniques.
            5. Crisis intervention methods.

            Skills

            1. Interpreting assessment and treatment planning materials to determine appropriateness of client or counselor referral.
            2. Assessing the client's readiness to participate in the referral process.
            3. Educating the client regarding appropriate referral processes.
            4. Motivating clients to take responsibility for referral and follow-up.
            5. Applying crisis intervention techniques.

            Attitudes

            1. Respect for the client’s ability to initiate and follow-up with referral.
            2. Willingness to share decision-making power with the client.
            3. Respect for the goal of positive self-determination.
            4. Recognition of the counselor’s responsibility to carry out client advocacy when needed.

            4. Arrange referrals to other professionals, agencies, community programs, or other appropriate resources to meet client needs.

            Knowledge

            1. Comprehensive treatment planning.
            2. Methods of assessing client’s progress toward treatment goals.
            3. How to tailor resources to client treatment needs.
            4. How to access key resource persons in community service provider network.
            5. Mission, function, and resources of appropriate community service providers.
            6. Referral protocols of selected service providers.
            7. Logistics necessary for client access and follow through with the referral.
            8. Applicable confidentiality regulations and protocols.
            9. Factors to consider when determining the appropriate time to engage client in referral process.

            Skills

            1. Using written and verbal communication for successful referrals.
            2. Using appropriate technology to access, collect, and forward necessary documentation.
            3. Conforming to all applicable confidentiality regulations and protocols.
            4. Documenting the referral process accurately.
            5. Maintaining and nurturing relationships with key contacts in community.
            6. Maintaining follow-up activity with client.

            Attitudes

            1. Respect for the client and the client’s needs.
            2. Respect for collaboration and cooperation.
            3. Respect for interdisciplinary, comprehensive approaches to meet client needs.

            5. Explain in clear and specific language the necessity for and process of referral to increase the likelihood of client understanding and follow through.

            Knowledge

            1. How treatment planning and referral relate to the goals of recovery.
            2. How client defenses, abilities, personal preferences, cultural influences, presentation, and appearance affect referral and follow through.
            3. Comprehensive referral information and protocols.
            4. Terminology and structure used in referral settings.

            Skills

            1. Using language and terms the client will easily understand.
            2. Interpreting the treatment plan and how referral relates to progress.
            3. Engaging in effective communication related to the referral process: - negotiating, - educating, - personalizing risks and benefits, - contracting.

            Attitudes

            1. Awareness of personal biases toward referral resources.

            6. Exchange relevant information with the agency or professional to whom the referral is being made in a manner consistent with confidentiality regulations and generally accepted professional standards of care.

            Knowledge

            1. Mission, function, and resources of the referral agency or professional.
            2. Protocols and documentation necessary to make referral.
            3. Pertinent local, State, and Federal confidentiality regulations, applicable client rights and responsibilities, client consent procedures, and other guiding principles for exchange of relevant information.
            4. Ethical standards of practice related to this exchange of information.

            Skills

            1. Using written and verbal communication for successful referrals.
            2. Using appropriate technology to access, collect, and forward relevant information needed by the agency or professional.
            3. Obtaining informed client consent and documentation needed for the exchange of relevant information.
            4. Reporting relevant information accurately and objectively.

            Attitudes

            1. Commitment to professionalism.
            2. Respect for the importance of confidentiality regulations and professional standards.
            3. Appreciation for the need to exchange relevant information with other professionals.

            7. Evaluate the outcome of the referral.

            Knowledge

            1. Methods of assessing client’s progress toward treatment goals.
            2. Appropriate sources and techniques for evaluating referral outcomes.

            Skills

            1. Using appropriate measurement processes and instruments.
            2. Collecting objective and subjective data on the referral process.

            Attitudes

            1. Appreciation of the value of the evaluation process.
            2. Appreciation of the value of inter-agency collaboration.
            3. Appreciation of the value of interdisciplinary referral.

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