Healthcare Apprenticeship Consortium - Washington

On-the-job Training

• SAMHSA TAP 21 Foundation 1: Understanding Addiction
  • Understand a variety of models and theories of addiction and other problems related to substance use.
  • Recognize the social, political, economic, and cultural context within which addiction and substance abuse exist, including risk and resiliency factors that characterize individuals and groups and their living environments.
  • Describe the behavioral, psychological, physical health, and social effects of psychoactive substances on the person using and significant others.
  • Recognize the potential for substance use disorders to mimic a variety of medical and mental health conditions and the potential for medical and mental health conditions to coexist with addiction and substance abuse.
• TAP 21 Foundation 2: Treatment Knowledge
  • Describe the philosophies, practices, policies, and outcomes of the most generally accepted and scientifically supported models of treatment, recovery, relapse prevention, and continuing care for addiction and other substance-related problems
  • Recognize the importance of family, social networks, and community systems in the treatment and recovery process
  • Understand the importance of research and outcome data and their application in clinical practice.
  • Understand the value of an interdisciplinary approach to addiction treatment.
• TAP 21 Foundation 3: Application to Practice
  • Understand the established diagnostic criteria for substance use disorders, and describe treatment modalities and placement criteria within the continuum of care.
  • Describe a variety of helping strategies for reducing the negative effects of substance use, abuse, and dependence
  • Tailor helping strategies and treatment modalities to the client's stage of dependence, change, or recovery.
  • Provide treatment services appropriate to the personal and cultural identity and language of the client.
  • Adapt practice to the range of treatment settings and modalities.
  • Be familiar with medical and pharmacological resources in the treatment of substance use disorders.
  • Understand the variety of insurance and health maintenance options available and the importance of helping clients access those benefits.
  • Recognize that crisis may indicate an underlying substance use disorder and may be a window of opportunity for change.
  • Understand the need for and use of methods for measuring treatment outcome
• TAP 21 Foundation 4: Professional Readiness
  • Understand diverse cultures, and incorporate the relevant needs of culturally diverse groups, as well as people with disabilities, into clinical practice.
  • Understand the importance of self-awareness in one's personal, professional, and cultural life.
  • Understand the addiction professional's obligations to adhere to ethical and behavioral standards of conduct in the helping relationship.
  • Understand the importance of ongoing supervision and continuing education in the delivery of client services.
  • Understand the obligation of the addiction professional to participate in prevention and treatment activities.
  • Understand and apply setting-specific policies and procedures for handling crisis or dangerous situations, including safety measures for clients and staff.
• TAP 21 Practice Dimension 1: Clinical Evaluation (Screening)
  • Establish rapport, including management of a crisis situation and determination of need for additional professional assistance.
  • Gather data systematically from the client and other available collateral sources, using screening instruments and other methods that are sensitive to age, developmental level, culture, and gender. At a minimum, data should include current and historic su
  • Screen for psychoactive substance toxicity, intoxication, and withdrawal symptoms; aggression or danger to others; potential for self-inflicted harm or suicide; and co-occurring mental disorders.
  • Assist the client in identifying the effect of substance use on his or her current life problems and the effects of continued harmful use or abuse.
  • Determine the client's readiness for treatment and change as well as the needs of others involved in the current situation.
  • Review the treatment options that are appropriate for the client's needs, characteristics, goals, and financial resources.
  • Apply accepted criteria for diagnosis of substance use disorders in making treatment recommendations.
  • Construct with the client and appropriate others an initial action plan based on client needs, client preferences, and resources available.
  • Based on the initial action plan, take specific steps to initiate an admission or referral and ensure followthrough.
• TAP 21 Practice Dimension 1: Clinical Evaluation (Assessment)
  • Select and use a comprehensive assessment process that is sensitive to age, gender, racial and ethnic culture, and disabilities that includes but is not limited to: ● History of alcohol and drug use ● Physical health, mental health, and addiction treatmen
  • Analyze and interpret the data to determine treatment recommendations
  • Seek appropriate supervision and consultation.
  • Document assessment findings and treatment recommendations.
• TAP 21 Practice Dimension 2: Treatment Planning
  • Use relevant assessment information to guide the treatment planning process.
  • Explain assessment findings to the client and significant others.
  • Provide the client and significant others with clarification and additional information as needed.
  • Examine treatment options in collaboration with the client and significant others.
  • Consider the readiness of the client and significant others to participate in treatment.
  • Prioritize the client's needs in the order they will be addressed in treatment.
  • Formulate mutually agreed-on and measurable treatment goals and objectives.
  • Identify appropriate strategies for each treatment goal.
  • Coordinate treatment activities and community resources in a manner consistent with the client's diagnosis and existing placement criteria.
  • Develop with the client a mutually acceptable treatment plan and method for monitoring and evaluating progress.
  • Inform the client of confidentiality rights, program procedures that safeguard them, and the exceptions imposed by regulations.
  • Reassess the treatment plan at regular intervals or when indicated by changing circumstances.
• TAP 21 Practice Dimension 3: Referral
  • Establish and maintain relationships 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 address unmet needs.
  • Continuously assess and evaluate referral resources to determine their appropriateness.
  • Differentiate between situations in which it is most appropriate for the client to self-refer to a resource and situations requiring counselor referral.
  • Arrange referrals to other professionals, agencies, community programs, or appropriate resources to meet the client's needs.
  • Explain in clear and specific language the necessity for and process of referral to increase the likelihood of client understanding and followthrough.
  • Exchange relevant information with the agency or professional to whom the referral is being made in a manner consistent with confidentiality rules and regulations and generally accepted professional standards of care.
  • Evaluate the outcome of the referral.
• Practice Dimension 4: Service Coordination - Implementing the Treatment Plan
  • Initiate collaboration with the referral source.
  • Obtain, review, and interpret all relevant screening, assessment, and initial treatment planning information
  • Confirm the client's eligibility for admission and continued readiness for treatment and change.
  • Complete necessary administrative procedures for admission to treatment.
  • Establish accurate treatment and recovery expectations with the client and involved significant others, including but not limited to: - The nature of services - Program goals - Program procedures - Rules regarding client conduct - The schedule of treatmen
  • Coordinate all treatment activities with services provided to the client by other resources.
• TAP 21 Practice Dimension 4: Service Coordination - Consulting
  • Summarize the client's personal and cultural background, treatment plan, recovery progress, and problems inhibiting progress to ensure quality of care, gain feedback, and plan changes in the course of treatment.
  • Understand the terminology, procedures, and roles of other disciplines related to the treatment of substance use disorders.
  • Contribute as part of a multidisciplinary treatment team.
  • Apply confidentiality rules and regulations appropriately
  • Demonstrate respect and nonjudgmental attitudes toward clients in all contacts with community professionals and agencies.
• TAP 21 Practical Dimension 4: Service Coordination - Continuing Assessment and Treatment Planning
  • Maintain ongoing contact with the client and involved significant others to ensure adherence to the treatment plan.
  • Understand and recognize stages of change and other signs of treatment progress.
  • Assess treatment and recovery progress, and, in consultation with the client and significant others, make appropriate changes to the treatment plan to ensure progress toward treatment goals.
  • Describe and document the treatment process, progress, and outcome.
  • Use accepted treatment outcome measures.
  • Conduct continuing care, relapse prevention, and discharge planning with the client and involved significant others.
  • Document service coordination activities throughout the continuum of care
  • Apply placement, continued stay, and discharge criteria for each modality on the continuum of care.
• TAP 21 Practical Dimension 5: Counseling - Individual Counseling
  • Establish a helping relationship with the client characterized by warmth, respect, genuineness, concreteness, and empathy.
  • Facilitate the client's engagement in the treatment and recovery process.
  • Work with the client to establish realistic, achievable goals consistent with achieving and maintaining recovery.
  • Promote client knowledge, skills, and attitudes that contribute to a positive change in substance use behaviors.
  • Encourage and reinforce client actions determined to be beneficial in progressing toward treatment goals.
  • Work appropriately with the client to recognize and discourage all behaviors inconsistent with progress toward treatment goals.
  • Recognize how, when, and why to involve the client's significant others in enhancing or supporting the treatment plan.
  • Promote client knowledge, skills, and attitudes consistent with the maintenance of health and prevention of HIV/AIDS, tuberculosis, sexually transmitted diseases, hepatitis C, and other infectious diseases.
  • Facilitate the development of basic and life skills associated with recovery.
  • Adapt counseling strategies to the individual characteristics of the client, including but not limited to disability, gender, sexual orientation, developmental level, culture, ethnicity, age, and health status.
  • Make constructive therapeutic responses when the client's behavior is inconsistent with stated recovery goals.
  • Apply crisis prevention and management skills.
  • Facilitate the client's identification, selection, and practice of strategies that help sustain the knowledge, skills, and attitudes needed for maintaining treatment progress and preventing relapse.
• TAP 21 Practical Dimension 5: Counseling - Group Counseling
  • Describe, select, and appropriately use strategies from accepted and culturally appropriate models for group counseling with clients with substance use disorders.
  • Carry out the actions necessary to form a group, including but not limited to determining group type, purpose, size, and leadership; recruiting and selecting members; establishing group goals and clarifying behavioral ground rules for participating; ident
  • Facilitate the entry of new members and the transition of exiting members
  • Facilitate group growth within the established ground rules and movement toward group and individual goals by using methods consistent with group type
  • Understand the concepts of process and content, and shift the focus of the group when such a shift will help the group move toward its goals.
  • Describe and summarize the client's behavior within the group to document the client's progress and identify needs and issues that may require a modification in the treatment plan.
• TAP 21 Practical Dimension 5: Counseling - Counseling Families, Couples, and Significant Others
  • Understand the characteristics and dynamics of families, couples, and significant others affected by substance use.
  • Be familiar with and appropriately use models of diagnosis and intervention for families, couples, and significant others, including extended, kinship, or tribal family structures.
  • Facilitate the engagement of selected members of the family or significant others in the treatment and recovery process.
  • Assist families, couples, and significant others in understanding the interaction between the family system and substance use behaviors.
  • Assist families, couples, and significant others in adopting strategies and behaviors that sustain recovery and maintain healthy relationships.
• TAP 21 Practice Dimension 6: Client, Family, and Community Education
  • Provide culturally relevant formal and informal education programs that raise awareness and support substance abuse prevention and the recovery process.
  • Describe factors that increase the likelihood for an individual, community, or group to be at risk for, or resilient to, psychoactive substance use disorders.
  • Sensitize others to issues of cultural identity, ethnic background, age, and gender in prevention, treatment, and recovery.
  • Describe warning signs, symptoms, and the course of substance use disorders.
  • Describe how substance use disorders affect families and concerned others.
  • Describe the continuum of care and resources available to the family and concerned others.
  • Describe principles and philosophy of prevention, treatment, and recovery.
  • Understand and describe the health and behavior problems related to substance use, including transmission and prevention of HIV/AIDS, tuberculosis, sexually transmitted diseases, hepatitis C, and other infectious diseases.
  • Teach life skills, including but not limited to stress management, relaxation, communication, assertiveness, and refusal skills
• TAP 21 Practice Dimension 7: Documentation
  • Demonstrate knowledge of accepted principles of client record management.
  • Protect client rights to privacy and confidentiality in the preparation and handling of records, especially in relation to the communication of client information with third parties.
  • Prepare accurate and concise screening, intake, and assessment reports.
  • Record treatment and continuing care plans that are consistent with agency standards and comply with applicable administrative rules.
  • Record progress of client in relation to treatment goals and objectives.
  • Prepare accurate and concise discharge summaries.
  • Document treatment outcome, using accepted methods and instruments.
• TAP 21 Practicel Dimension 8: Professional and Ethical Responsibilities
  • Adhere to established professional codes of ethics that define the professional context within which the counselor works to maintain professional standards and safeguard the client.
  • Adhere to Federal and State laws and agency regulations regarding the treatment of substance use disorders.
  • Interpret and apply information from current counseling and psychoactive substance use research literature to improve client care and enhance professional growth.
  • Recognize the importance of individual differences that influence client behavior, and apply this understanding to clinical practice.
  • Use a range of supervisory options to process personal feelings and concerns about clients.
  • Conduct self-evaluations of professional performance applying ethical, legal, and professional standards to enhance self-awareness and performance.
  • Obtain appropriate continuing professional education.
  • Participate in ongoing supervision and consultation.
  • Develop and use strategies to maintain one's physical and mental health.
• Additional Competencies: Communication
  • Engages in active and reflective listening.
  • Uses 'person centered/person first' language.
  • Speaks clearly and slowly enough to be understood.
• Additional Competencies: Assessment
  • Assess client's preferred method of communication and language barriers.
• Additional Competencies: Medication Management
  • Review the list of the client's medications, their effects and side effects.
  • Coaches the client on strategies for taking medications as prescribed.
  • Coaches the family on strategies for supporting the client in taking medications.
  • Assists the client in monitoring and reporting medication effects and side effects to the medical prescriber.
• Additional Competencies: Counseling
  • Helps the client define the problem by telling their story, discussing their situation, and challenging his or her current perspective, when warranted.
• Additional Competencies: Crisis Management/Suicide
  • Assists in implementing the response to an individual, family, or community crisis.
  • Communicates with the family and others about the crisis and the response.
  • Assists with notifications and investigations of reportable events (e.g., abuse, domestic violence, assaults, neglect, deaths).
  • Assists the client and family in obtaining services related to the crisis (e.g. domestic violence shelter; emergency foster care).
  • Participates in debriefing meetings to discuss the crisis and the response.
• Additional Competencies: Cultural Competency and Individualized care
  • Is aware of and able to manage their own stereotypes and biases, as it relates to race, gender, class, ability, age, sexual orientation, immigration status, religion, and other marginalized groups. Has learned skills to recognize and work on new biases as
  • Is aware of their privileged identities and uses their privilege to advocate on behalf of those who experience marginalization, being mindful not to do for their clients what they can do for themselves.
  • Leading with race as a foundation; applies knowledge of race, ethnicity, gender identity, sexual orientation, life span development, socio economic status, religion, disability, immigration status, and intergenerational differences when delivering service
  • Utilizes a strength-based model, promoting empowerment as a goal and desirable treatment outcome for all people by fostering client and family decision-making, problem-solving, and self-determination.
  • Takes risk and leans into their discomfort to engage clients in conversations about their experiences related to race, class, gender, sexual orientation, ability, and immigration status.
  • Takes risks to engage clients in dynamics of differences that exist between themselves and their clients.
  • Utilizes appropriate culturally relevant resources and a combination of traditional and client-centered practices when providing services (e.g., storytelling, talking circles, and deferring to elders), while being mindful of cultural appropriation.
  • Understands and applies knowledge of the systemic roots of addiction, history of drugs in America, and the intersection of failed interventions and racism. Also understands resiliency and what is working in interventions.
  • Understands and applies knowledge of the compounding effects of having more than one identity (e.g., race, class, gender, sexual orientation, immigration status, ability, age) and more than one variable (e.g., addiction, previous incarceration) and the im
  • Has knowledge of and works to mitigate the mental health and cultural stigma around substance use; acts as an advocate
  • Applies knowledge of implicit bias to institutions; advocates for change when an institutional policy or procedure has a bias.
  • Demonstrates foundational knowledge of microaggressions and engages in courageous conversations when they witness, experiences, or commit a microaggression or other offenses.
  • Applies knowledge that the tools and infrastructure of mental health diagnosis and care is inherently biased and has been used to further racism. Acknowledges cultural trauma and adjusts patient care appropriately.
  • Provides culturally appropriate, trauma-informed care and healing from multiple angles. Understands health disparities in the context of mental health.
  • Effectively integrates culturally responsive practices and skillfully adapts utilizing multiple practices - e.g. motivational interviewing, group facilitation, trauma-informed practices, health and social systems navigation.
  • Engages client to increase understanding of how the person sees the world and how they view the world seeing them (e.g., shapes, trust, and respect; impact of oppression, systemic racism, discrimination).
  • Understands the compounding impact of incarceration, poverty, and/or other systems involvement (i.e. foster care, homelessness).
  • Is flexible in care, communication, and approach so the client feels comfortable being themselves.
  • Demonstrates awareness of how the power differential between the care provider and the client impacts the helping relationships.
  • Understands the complexity of dual relationships and how to navigate ethically.
  • Routinely considers and discusses cultural responsiveness in supervision and team meetings.
  • Consults with elders or traditional healers in the community when appropriate.
  • Works within the limits of assigned duties and role.
  • Recognizes personal limits of knowledge and skills.
  • Complies with special rules and procedures related to consent for: involuntary commitment; mandated reporting; minors; on individuals unable to consent, under guardianship, or subject to a court order.
  • Recognizes signs of personal stress.
• Additional Competencies: Professional and Ethical Conduct
  • Minimizes absences, arrives, on time, and completes a full work day.
• Additional Competencies: Promotes Leadership and Advocacy
  • Participates in efforts to eliminate prejudice and discrimination of people who have behavioral health conditions and their families.
  • Actively participates in efforts to improve the organization.