TIP 38 Integrating Substance Abuse Treatment and Vocational Services

250 Pages·2004·2.81 MB·English

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

Integrating Substance

Abuse Treatment and

Vocational Services

Treatment Improvement Protocol (TIP) Series

38
Integrating
Substance
Abuse
Treatment and
Vocational
Services
Treatment Improvement Protocol (TIP) Series
38

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment

1 Choke Cherry Road
Rockville, MD 20857
Acknowledgments  Electronic  Access  and  Printed  Copies 
This  publication  was  prepared  under  contract   This  publication  may  be  ordered  from  or  
number  270‐05‐0013  for  the  Substance  Abuse   downloaded  from  SAMHSA’s  Publications 
and  Mental  Health  Services  Administration   Ordering  Web  page  at  http://store.samhsa.gov.  
(SAMHSA),  U.S.  Department  of  Health  and   Or,  please  call  SAMHSA  at  1‐877‐SAMHSA‐7  (1‐
Human  Services  (HHS).  Sandra  Clunies,  M.S.,  877‐726‐4727)  (English  and  Español). 
ICADC,  served  as  the  Contracting  Officer’s    
Representative.    Recommended  Citation 
  Center  for  Substance  Abuse  Treatment.  
Disclaimer  Integrating  Substance  Abuse  Treatment  and 
The  opinions  expressed  herein  are  the  views  of  Vocational  Services.  Treatment  Improvement 
the  consensus  panel  members  and  do  not  Protocol  (TIP)  Series,  No.  38.  HHS  Publication  
necessarily  reflect  the  official  position  of  No.  (SMA)  12‐4216.  Rockville,  MD:  Substance  
SAMHSA  or  HHS.  No  official  support  of  or   Abuse  and  Mental  Health  Services  
endorsement  by  SAMHSA  or  HHS  for  these   Administration,  2000. 
opinions  or  for  the  instruments  or  resources   
described  are  intended  or  should  be  inferred.   Originating  Office 
The  guidelines  presented  should  not  be   Quality  Improvement  and  Workforce 
considered  substitutes  for  individualized  client  Development  Branch,  Division  of  Services  
care  and  treatment  decisions.  Improvement,  Center  for  Substance  Abuse 
  Treatment,  Substance  Abuse  and  Mental  Health 
Public  Domain  Notice  Services  Administration,  1  Choke  Cherry  Road,  
All  materials  appearing  in  this  volume  except  Rockville,  MD  20857. 
those  taken  directly  from  copyrighted  sources   
are  in  the  public  domain  and  may  be   HHS  Publication  No.  (SMA)  12‐4216 
reproduced  or  copied  without  permission  from  First  Printed  2000 
SAMHSA  or  the  authors.  Citation  of  the  source  Revised  2002,  2003,  2006,  2010,  2012,  and  2014 
is  appreciated.  However,  this  publication  may    
not  be  reproduced  or  distributed  for  a  fee   
without  the  specific,  written  authorization  of  the 
Office  of  Communications,  SAMHSA,  HHS. 

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Contents
What Is a TIP?..........................................................................................................................................................vii
Editorial Advisory Board........................................................................................................................................ ix
Consensus Panel ...................................................................................................................................................... xi
Foreword.................................................................................................................................................................. xiii
Executive Summary and Recommendations...................................................................................................... xv
Recommendations............................................................................................................................................ xvii
Chapter 1—The Need for Vocational Services .....................................................................................................1
Employment as a Goal..........................................................................................................................................2
Challenges to Employing Clients in Treatment ................................................................................................3
Vocational Issues...................................................................................................................................................6
Treatment and Employment................................................................................................................................9
National Trends Affecting Employment..........................................................................................................11
Chapter 2—Vocational Programming and Resources .......................................................................................17
Vocational Rehabilitation Counseling..............................................................................................................17
Screening and Assessment.................................................................................................................................19
Vocational Counseling .......................................................................................................................................27
Prevocational and Ongoing Services................................................................................................................29
Training and Education......................................................................................................................................30
Employment Services .........................................................................................................................................33
Overview of Vocational Resources...................................................................................................................36
Chapter 3—Clinical Issues Related to Integrating Vocational Services ........................................................47
Incorporating Vocational Services....................................................................................................................47
Competency Areas for Employment................................................................................................................52
Developing the Treatment Plan ........................................................................................................................62
Case Studies.........................................................................................................................................................69
Chapter 4—Integrating Onsite Vocational Services..........................................................................................75
Planning an Integrated Program.......................................................................................................................76
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Contents
Implementing and Operating the Integrated Program..................................................................................80
Outcomes .............................................................................................................................................................87
Uniform Data Collection....................................................................................................................................88
Chapter 5—Effective Referrals and Collaborations ..........................................................................................91
Collaboration as the Cornerstone of Effective Referral..................................................................................91
Authentically Connected Referral Networks ..................................................................................................96
Building an Authentically Connected Referral Network ..............................................................................99
Chapter 6—Funding and Policy Issues ..............................................................................................................101
Managed Care Contracts as a Funding Source .............................................................................................101
Impact of Policy and Funding Shifts ..............................................................................................................102
Future Considerations......................................................................................................................................108
Federal and State Funding Sources ................................................................................................................110
Endnotes.............................................................................................................................................................116
Chapter 7—Legal Issues .......................................................................................................................................119
Part I: Discrimination in Employment and Employment-Related Services..............................................119
Part II: The Revolution in Rules Governing Public Assistance...................................................................132
Part III: Confidentiality of Information About Clients.................................................................................135
A Final Note.......................................................................................................................................................151
Endnotes.............................................................................................................................................................151
Chapter 8—Working With the Ex-Offender .....................................................................................................153
Barriers to Employment: What the Offender Brings to the Process...........................................................154
Barriers to Employment: What Society Brings to the Process.....................................................................160
Program Examples............................................................................................................................................164
Endnotes.............................................................................................................................................................164
Appendix A—Bibliography .................................................................................................................................167
Appendix B—Resources: Tools and Instruments ............................................................................................179

Appendix C—Published Resource Materials ...................................................................................................191

Internet Sites ......................................................................................................................................................192

Software..............................................................................................................................................................192

Appendix D—Addiction Severity Index ...........................................................................................................193

Appendix E—State Employment Agencies .......................................................................................................205

Appendix F—Federal Funding Sources .............................................................................................................211

Appendix G—Sample Individualized Written Rehabilitation Program .....................................................217

Appendix H—Resource Panel .............................................................................................................................221

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Contents
Appendix I—Field Reviewers .............................................................................................................................223

Figures
1-1 Challenges to Employment .........................................................................................................................4
1-2 Strategies for Promoting Employment ......................................................................................................8
2-1 Vocational Services Provided to a Residential Treatment Facility ......................................................19
2-2 Vocational Information From Initial Screen............................................................................................21
2-3 Assessment Tools .......................................................................................................................................26
2-4 Prevocational Counseling Activities........................................................................................................30
2-5 Job Search Resources: America’s Job Bank on the Internet...................................................................34
2-6 Vocational Opportunities of Cherokee, Inc.: Rehabilitation Facility Providing
Primarily Onsite Services ..........................................................................................................................37
2-7 The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency:
A Case Management Model......................................................................................................................39
2-8 Combating Alcohol and Drugs Through Rehabilitation and Education (CADRE)...........................41
2-9 The Texas Workforce Commission: Project RIO (Re-Integration of Offenders) ................................42
2-10 Basic Materials for a Vocational Reference Library ...............................................................................44
3-1 Early-Stage Vocational Issues and Approaches .....................................................................................50
3-2 Answering Questions Related to Substance Use History—A Sample Scenario ................................57
4-1 Steps for Planning an Integrated Program..............................................................................................76
4-2 Job Clubs......................................................................................................................................................83
4-3 Focus on Client Outcomes: The Future for Substance Abuse Treatment Providers .........................89
5-1 Data-Matching Software............................................................................................................................94
5-2 Steps for Establishing an Authentically Connected Network ..............................................................95
5-3 Characteristics of Authentically Connected Referral Networks ..........................................................98
6-1 Agency Self-Assessment Categories ......................................................................................................105
7-1 Americans With Disabilities Act and Rehabilitation Act Protections ...............................................125
7-2 Services Provided Under the Workforce Investment Act of 1996......................................................126
7-3 Sample Consent Form..............................................................................................................................138
7-4 Making a Referral to a Vocational or Training Program.....................................................................143
8-1 A Program That Addresses Women’s Issues........................................................................................160
8-2 Summary of Program Examples.............................................................................................................166
F-1 Federal Funding Sources .........................................................................................................................212
F-2 Federal Sources of Discretionary, Time-Limited Project Grants........................................................216

v

What  Is  a  TIP?

T reatment  Improvement  Protocols  (TIPs)  to  facilities  and  individuals  across  the  country.  
are  developed  by  the  Substance  Abuse  Published  TIPs  can  be  accessed  via  the  Internet 
and  Mental  Health  Services  at  http://store.samhsa.gov. 
Administration  (SAMHSA)  within  the  U.S.  
Although  each  consensus‐based  TIP  strives  
Department  of  Health  and  Human  Services 
to  include  an  evidence  base  for  the  practices  it 
(HHS).  Each  TIP  involves  the  development  of  
recommends,  SAMHSA  recognizes  that 
topic‐specific  best‐practice  guidelines  for  the  
behavioral  health  is  continually  evolving,  and  
prevention  and  treatment  of  substance  use  and 
research  frequently  lags  behind  the  innovations  
mental  disorders.  TIPs  draw  on  the  experience 
pioneered  in  the  field.  A  major  goal  of  each  TIP  
and  knowledge  of  clinical,  research,  and 
is  to  convey ʺfront‐lineʺ information  quickly  but 
administrative  experts  of  various  forms  of  
responsibly.  If  research  supports  a  particular  
treatment  and  prevention.  TIPs  are  distributed 
approach,  citations  are  provided. 

  vii

Editorial  Advisory  Board 

Note:  The  information  given  indicates  each  participantʹs  affiliation  during  the  time  the board was  
convened  and  may  no  longer  reflect  the  individualʹs  current  affiliation.  
Karen  Allen,  Ph.D.,  R.N.,  C.A.R.N. 
Pedro  J.  Greer,  M.D. 
Professor  and  Chair 
Assistant  Dean  for  Homeless  Education 
Department  of  Nursing 
University  of  Miami  School  of  Medicine 
Andrews  University 
Miami,  Florida 
Berrien  Springs,  Michigan 
Thomas  W.  Hester,  M.D. 
Richard  L.  Brown,  M.D.,  M.P.H. 
Former  State  Director 
Associate  Professor 
Substance  Abuse  Services 
Department  of  Family  Medicine 
Division  of  Mental  Health,  Mental 
University  of  Wisconsin  School  of  Medicine 
   Retardation  and  Substance  Abuse 
Madison,  Wisconsin 
Georgia  Department  of  Human  Resources 
Dorynne  Czechowicz,  M.D.   Atlanta,  Georgia 
Associate  Director 
James  G.  (Gil)  Hill,  Ph.D. 
Medical/Professional  Affairs 
Director 
Treatment  Research  Branch 
Office  of  Substance  Abuse 
Division  of  Clinical  and  Services  Research 
American  Psychological  Association 
National  Institute  on  Drug  Abuse 
Washington,  D.C. 
Rockville,  Maryland 
Douglas  B.  Kamerow,  M.D.,  M.P.H. 
Linda  S.  Foley,  M.A. 
Director 
Former  Director  
Center  for  Practice  and  Technology 
Project  for  Addiction  Counselor  Training  
    Assessment 
National  Association  of  State  Alcohol  and 
Agency  for  Health  Care  Policy  and  Research 
   Drug  Abuse  Directors 
Rockville,  Maryland 
Director 
Treatment  Improvement  Exchange  Project  Stephen  W.  Long 
Washington,  D.C.  Director 
Office  of  Policy  Analysis 
Wayde  A.  Glover,  M.I.S.,  N.C.A.C.  II 
National  Institute  on  Alcohol  Abuse  and 
Director 
   Alcoholism 

Commonwealth  Addictions  Consultants  and 
Rockville,  Maryland

   Trainers 

Richmond,  Virginia 

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