ADC Exam 6

140. Treatment plans should refer to the type of program service modality being offered. Which of the following is NOT a common modality? a. Residential b. Outpatient c. Scholastic d. Perinatal

140. C: The types of program service modalities most commonly include: (1) residential; (2) outpatient; (3) day care habilitative; (4) narcotic treatment program; and (5) perinatal. Common goal areas include: (1) substance use; (2) medical issues; (3) legal issues; (4) psychosocial progress; (5) educational or vocational; (6) employment; (7) financial; (8) discharge; and (9) other. Progress notes addressing the goals should include references to the specific area being targeted by the goals or action plans. In the progress note, the counselor writes out what they did to facilitate accomplishment of the goal. The counselor should also record objective impressions regarding the client's behavior, attitudes, and efforts to achieve long- and short-term objectives found in the treatment plan.

114. What is a brief, but comprehensively integrated public health approach to early substance abuse intervention and treatment known as? a. Treatment, Brief Intervention, Referral, and Screening (TBIRS) b. Brief Intervention, Screening, Referral, and Treatment (BISRT) c. Referral, Screening, Brief Intervention, and Treatment (RSBIT) d. Screening, Brief Intervention, and Referral to Treatment (SBIRT)

114. D: The Screening, Brief Intervention, and Referral to Treatment (SBIRT) public health approach is designed for use in hospital emergency departments, trauma centers, primary care clinics, and other health care settings. The goal is to identify diagnosable substance abuse disorders as well as those at-risk for developing a disorder before serious consequences develop. Each key component has a specific function toward this end: (1) screening—identifying and rapidly assessing substance use severity and determining the appropriate treatment level needed; (2) brief intervention—enhancing clients' awareness and insights regarding substance abuse consequences as well as motivating the client toward behavioral change; (3) referral to treatment—linking clients to specialized substance abuse treatment options as assessment indicates is needed and appropriate.

115. What is the key feature that differentiates a substance abuse counselor who merely practices in the field from one who succeeds in changing clients' lives? a. The knowledge of addiction issues b. The ability to be empathetic c. The skill to set clear boundaries d. The capacity to firmly confront

115. B: The ability to work with genuine compassion for clients is the first essential feature of successful counseling, provided appropriate boundaries are also maintained. Skills, knowledge, and information specific to the client's situation and needs are essential but are substantially ineffective if not managed with compassion and care. The renowned psychologist Carl Rogers taught that every individual has a positive, trustworthy center if this psychological core can be accessed. Connecting with this center taps into an individual's resourcefulness and capability for self-understanding and positive self-direction. To this end, he promoted three keys: (1) congruence (genuineness); (2) unconditional positive regard (caring concern and compassion); and (3) accurate, empathetic understanding (the ability to meaningfully assume the client's subjective perspective). Using these tools, clients can be reached and motivated toward positive change.

116. A great deal is communicated nonverbally in the counseling process. How much communication does nonverbal body language account for, according to research? a. 10 percent b. 25 percent c. 50 percent d. 75 percent

116. C: The pioneering University of California, Los Angeles (UCLA) nonverbal communication researcher Albert Mehrabian has revealed that approximately 50 percent of all communication is exchanged nonverbally in the form of body language. According to Mehrabian, there are three fundamental elements in face-to-face communication: (1) the actual words used; (2) the tone of voice used; and (3) nonverbal behaviors (e.g. facial expression, body posture, gestures, etc.). If the nonverbal elements are incongruent, the behavior and tonality tend to be seen as more genuine than any words expressed. Given the importance of genuine compassion and empathy in the therapeutic process, body language is particularly important. To optimize nonverbal communication, the counselor should be seated two to four feet from the client, with no intervening barrier (e.g., a desk), leaning forward, legs and arms uncrossed, hands open, nodding to communications expressed, and making direct eye contact (if cultural permits it). The client's body movements (including micro-movements, such as nostril flaring or quivering chin) should be noted and responded to appropriately.

117. During the intake process, it is important for clients to sign an informed consent form. Of the following, what is the MOST significant reason for signing this form? a. To acquaint clients with program rules, regulations, and boundaries b. To ensure full compliance with program accreditation standards c. To better develop a meaningful treatment plan d. To ensure client commitment to and readiness for treatment

117. A: Individuals with a history of substance abuse often come out of families, relationships, and environments with few if any boundaries or rules. Further, due to long-standing issues of shame and embarrassment over substance abuse, clients are often overly sensitive to feelings of critique and failure. Consequently, it is particularly important for clients to become aware of the rules, regulations, and boundaries of treatment program participation in advance. In this way, clients need not be surprised when redirected to existing boundaries and standards of conduct. In turn, this consistency creates an environment that feels more stable, predictable, and safe from the clients' perspective, which is important as they work to muster and maintain the motivation to make important changes in their lives. The program's informed consent process also leads naturally into identifying and establishing the early treatment goals needed to motivate, shape, and monitor clients' success.

118. The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a national registry known as NREPP. What does this acronym refer to? a. National Registry of Examinations for Psychological Practices b. National Registry of Excellence in Program Practicum c. National Registry of Evidence-Based Programs and Practices d. National Registry of Examiners for Program Procedures

118. C: The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains the National Registry of Evidence-Based Programs and Practices (NREPP), which is a database of evidence-supported approaches to substance abuse counseling. The goal is to make available those theories, strategies, programs, and practices that have been proven effective in the treatment of substance abuse disorders. The database includes approaches such as twelve-step facilitation therapy, cognitive-behavioral therapy (CBT), and motivational interviewing (MI), among others. The database offers evaluations, recommendations, and suggestions to optimize the effectiveness of the various programs reviewed. The database is readily accessible via the Internet, and counselors should become familiar with the various programs, techniques, theories, and approaches offered to ensure optimal practices and program outcome effectiveness.

119. It is important to determine a client's readiness for change at the outset of treatment. From among the following, what is the BEST indicator of readiness? a. A client's statement of his or her readiness for change b. The client and family's level of emotional and physical pain c. The client and family's admission that there is a substance abuse problem d. A client's changes in finances required to continue the substance abuse

119. B: There are many things that offer indication of readiness for change. Clients having hit bottom and families that have reached a breaking point are often poised for change. A skilled counselor can sometimes create a false bottom by breaking through denial using a pointed but caring presentation of reality in such a way as to motivate change. Engaging the family in the recovery process is often as important as engaging the client in recovery. Families have to deal with their own emotional pain and shame and learn how to make choices from the perspective of whether or not each choice will help or hinder the recovery of their loved one. Learning to avoid enabling patterns is also crucial, along with family referrals to support groups and literature sources that will ensure understanding and enduring commitment to the recovery process.

120. Significant substance abuse can arrest personal progress and growth in many ways. How will emotional and other normal developmental stages MOST likely be affected? a. They will progress more slowly due to significant substance abuse. b. They will progress more rapidly due to significant substance abuse. c. They will be largely skipped due to significant substance abuse. d. They remain unchanged due to significant substance abuse.

120. C: A common rule of thumb in the field of substance abuse treatment is that the age at which significant substance abuse began is the point at which personal progress through normal developmental stages was arrested or missed altogether. Thus, people who began heavy drug use in their mid-teens will often have failed to master the developmental stages from that point forward until they returned to sobriety. Thus, teen issues of self-esteem, self-image, balanced relationships with the opposite sex, responding to authority, impulse control, and so on, will likely still need to be mastered. One role of the counselor will be to identify, inventory, and produce a learning plan to belatedly secure these important developmental learning tasks. To more fully structure the process of growth, clients will need to learn to adhere to a healthy living schedule—including timely morning wake-up, personal hygiene and living space cleanup, set meal times, work, group meetings, personal exercise and meditation, and wholesome bedtimes.

121. The impact of substance abuse in the family varies based on the user's family position, role, age, and so on. What is one reason substance abuse in the family is NOT initiated or maintained? a. The need to exert control over other family members b. The need to produce a crisis to get any meaningful attention c. The need to cope with severe depression or anxiety d. The need to cope with unrealistic expectations

121. A: Issues of control over others are not prominent in reasons to begin or continue using drugs. Patterns of intrafamilial interaction that are common in families with substance abuse include: (1) negativity-criticism, complaints, and expressions of displeasure dominate, which may then reinforce the need for substance abuse; (2) misdirected anger-resentment over an emotionally deprived home ruled by fear encourages drug use to cope; (3) boundary inconsistency-unpredictable rules, inconsistent responses, and erratic boundaries lead to family member stress (especially among children), misbehavior, and a greater likelihood of substance abuse; (4) self-medication-coping with anxiety, depression, or intrusive thoughts can lead to substance abuse; (5) unrealistic expectations-leads family members to opt out through drug use; (6) denial-excusing or denying substance abuse allows its perpetuation. Where present, a complete restructuring of the family system, with education and interventions, is needed to abate any of these highly problematic issues.

122. There are numerous methods used to encourage a substance abuser to enter treatment. Who carries out a programmed confrontation? a. A trained addictions counselor b. A primary care physician c. A psychotherapist d. A family member

122. D: Programmed confrontation is a method used to mobilize a substance user (typically a husband) to accept treatment. It is carried out by a family member (typically a wife). To effectively engage programmed confrontation, the family member receives training in Unilateral Family Therapy (UFT). The training is conducted over a period of months, covering important issues such as personal coping (with the addict's abuse), helping him or her cut back on substance use, and ways to encourage treatment acceptance. By the fifth month, the addict is typically prepared. UFT was influenced by the community reinforcement approach (CRA), and the Johnson Intervention. The Johnson Intervention utilizes family mobilization, coaching, and rehearsing to motivate a potential client into treatment-usually using an element of surprise. The model focuses on the addict's positive traits and the negative changes that result from addiction. Specific examples of behavior issues are presented in a loving, caring manner to break through the addict's denial and encourage treatment. The UFT success rate is 37 percent entering treatment, compared to 11 percent where no UFT techniques were involved.

123. Substance abuse takes a toll on all involved. How is community reinforcement training (CRT) used? a. To assist a substance user to reduce his or her level of use b. To keep drug use paraphernalia clean and disease free c. To motivate a substance user to enter a treatment program d. To persuade heroin users not to share needles with others

123. C: Community reinforcement training (CRT) is an approach used by families to hasten a user into treatment. The initial step involves seeing users' loved ones who call for help on a same-day basis. At this first contact, they are enrolled in a training program to learn the steps needed to produce motivation and change. The program begins by teaching the family members how to produce a safety plan for themselves if they are in any way at risk of physical abuse. Then they are taught how to encourage abstinence, followed by ways to encourage treatment seeking. Finally, when the addict reaches a crisis point, the program is structured to bring him or her into treatment virtually immediately, regardless of the time of day or night. In one study, this nonconfrontational and expedited approach resulted in 86 percent of users entering treatment, while none of those using a traditional approach were successfully engaged.

124. Motivating an addict to enter treatment is often difficult. Which treatment entry method uses the intervention network as part of its motivational process? a. The Johnson Method b. Community reinforcement training (CRT) c. The ARISE Method d. The community reinforcement approach (CRA)

124. C: The ARISE method uses a three-level approach to motivate an addict to enter treatment. Level 1 (The First Call) begins with a telephone consultation, followed by a first meeting of an intervention network (IN). The IN consists of immediately involved significant others (spouse, family, and close friends) who then meet with the addict to encourage treatment. Faced with the collective encouragement of the IN, approximately 56 percent of addicts will then enter treatment. Level 2 (Strength in Numbers) expands the IN to include more family, friends, potentially even employers, and a therapist, citing specific examples of concerns and the need for treatment. The IN acts in concert to avoid no-win one-on-one contacts. Within two to five meetings 80 percent will enter treatment. Level 3 (Formal Intervention) is more confrontational, as significant consequences of avoiding treatment are spelled out (all enabling behaviors to stop with more serious consequences to follow). Another 3 percent (i.e., 83 percent in total) will then accept treatment, and 61 percent of all will still be sober by the end of the first year.

125. Families have much to offer the treatment process. Beyond client abstinence, what is the main goal of involving the family in treatment? a. To corner an addict into making changes by escalating family pressure b. To help the family to better cope with the client's addictive behaviors and the related consequences c. To teach the family about the biological processes that underlie addiction d. To educate the family about substance abuse as a chronic disorder requiring lifelong changes

125. D: This education can help the family to collaborate in the changes needed for the client to achieve and sustain sobriety throughout his or her life. Other benefits of drawing the family in include: (1) increase the client's motivation to change; (2) alter family patterns that may be obstacles to recovery; (3) help the family anticipate needs and issues through the various recovery stages; (4) teach relapse warning signs they can identify; (5) teach a family perspective on the causes and effects of substance abuse; (6) coopting family strengths on behalf of the client; and (7) help the family to find long-term support. In this way, support is optimized, client progress is maximized, family welfare is preserved, and outcomes are improved.

126. There are numerous reasons for not involving the family in treatment. Who are the family members MOST likely to participate in treatment? a. Adult children b. Adult siblings c. Adult women d. Adult men

126. C: Men are much less likely to participate in the treatment of their female partners. Common obstacles to family involvement include: (1) resistance from the addict; (2) domestic violence issues; (3) family secrets that might come out; and (4) family resource burdens. Approaches to overcome resistance to family involvement include: (1) request family participation in intake (encouraging this with the client as well), citing policy, history intake needs, help for the client, and family support as reasons; (2) ask the client to collaborate in planning the family engagement; (3) send family a written invitation; (4) provide incentives (refreshments, coupons, etc.); (5) offer food (picnics, dinners, etc.); (6) program resources (babysitting, children's toys, flexible hours, etc.); (6) welcome environment (clean, cheerful, etc.); (7) ice-breaking activities (games, role-play, activities, etc.); (8) use community reinforcement training (CRT) to teach that the family is not to blame and that substance abuse isn't a moral flaw in addition to teaching them how to meet personal and family needs, how to support the client, and so on, to help increase understanding and make them feel more welcome and positive.

127. There are many approaches and techniques that may be used to help families understand addiction and support sobriety. How does the Bowen family systems theory view the family? a. An interdependent emotional unit b. Autonomous members in a collective c. Functional co-participants in limited endeavors d. Disparate participants seeking harmony

127. A: Bowen family systems theory views the family as an integrated emotional unit, best described and understood via a systems perspective when attempting to describe the complex interactions that arise in the unit. Family members are intensely emotionally connected and profoundly influence the feelings, thoughts, and actions of each other. They seek attention, support, and approval from each other and respond to one another's distress, needs, and expectations. Changes in the functioning of any one member will be followed by reciprocal changes in the others. From this perspective, family genograms, disruption history (e.g., immigration, holocaust, etc.), individual questioning, and orienting the members toward facts (versus reactions) can help improve family understandings and function. Coaching individuals into changes in interaction patterns can reduce triangulation and overall family anxiety.

128. When helping families adjust to and maintain in-home sobriety, what is the therapeutic intervention that draws upon extended support linkages to produce motivation and reinforcement known as? a. Structural or strategic systems therapy b. Network therapy c. Cognitive-behavioral therapy d. Multidimensional family therapy

128. B: Network therapy builds an extended collection of involved persons (social workers, school counselors, legal representatives, therapists, etc.) to meet, motivate, and reinforce changes and progress in the family. Extensive interviews help determine family needs and appropriate referrals to resources such as support groups, counseling, and so on, to help break the cycle of addiction. Other therapeutic options include: (1) Multidimensional family therapy uses support groups, interviews, and therapeutic interactions to discover issues, map out responses, and contract with involved family members to address, curtail, or resolve key family issues. New family skills, such as better communication and conflict resolution, relapse prevention, and coping strategies for any psychiatric disorders in the family, are all needed for enhanced family functioning. (2) Cognitive-behavioral family therapy uses factual constructs, improved communication and negotiation skills, contingency contracting, and better problem definitions to produce enhanced family functioning. (3) Structural or strategic systems therapy restructures roles, realigns subsystems and boundaries, and reestablishes more extended intergenerational boundaries to improve family function and cohesion.

129. Many therapeutic approaches might be helpful in working with families of addicts. Of those commonly used, which brief therapeutic approach uses the miracle question technique? a. Cognitive-behavioral therapy b. Bowen family systems therapy c. Multidimensional family therapy d. Solution-focused family therapy

129. D: This form of brief therapy focuses on helping clients to identify solutions to vexing problems. Asking clients to recall a time when the problem was not present or so severe, and then asking what they or others had done differently, can help in identifying potential solutions. Further, asking about exceptions to the problem (when it could have occurred but didn't) can also be helpful. Using the miracle question involves asking this: "If a miracle occurred and the problem went away, what would be the first sign (and then what signs would follow)?" Scaling questions allow clients to scale a problem from 0 (worst) to 10 (resolved) and then to discuss why they selected that number to find clarity (comparing couples or family answers can also help). Coping questions ask "How have you managed to carry on to this point?" to find strengths. Using consultation breaks at the half-session mark and pondering the answers, followed by compliments, encouragement, and ideas, can also help. Compliments and a future focus (instead of the past) keep the work positive and solution focused.

130. Genetic factors can play a significant role in an individual's susceptibility to substance abuse and addiction. It is estimated that genetic factors account for a. 20 to 40 percent of addiction vulnerability. b. 30 to 50 percent of addiction vulnerability. c. 40 to 60 percent of addiction vulnerability. d. 50 to 70 percent of addiction vulnerability.

130. C: While no single factor can account for all vulnerability, genetics appears to play a significant role. Other potential factors include gender, development stage, social environment, and culture or ethnicity. Known environmental risk factors include: unemployment or underemployment, high neighborhood crime rates, prevalence of illicit drugs (including cost and ease of procurement), poor housing (dilapidated or overcrowded), peer pressures, community attitudes, and low social achievement expectations. Known cultural or ethnic/racial risk factors include: minority status, discrimination based on race, intergenerational assimilation disparity, language and cultural barriers to social services and health care, poor educational achievement, cultural devaluation in the dominant society, and cultural alienation. Known family risk factors include: poor bonding, highly chaotic home, family conflict and violence, financial strain, home stress, parental substance abuse, parental neglect, and parental mental illness. Known emotional or behavioral risk factors include: low self-esteem, aggression, rebelliousness, high independence needs, nonconformity, shyness, delinquency, emotional problems, suicidality, relationship problems, using gateway drugs, and academic and drop-out problems.

131. Numerous factors have protective influences against the development of substance abuse and addiction. If the home itself is a high-risk environment (parental drug use, etc.), how can a minor's healthy development be optimized? a. They distance themselves from their dysfunctional families. b. They develop a talent, skill, or something valued by others. c. They do neither A nor B. d. They do both A and B.

131. D: Where a high-risk home life exists, a minor child will fare better if he or she is able to distance him- or herself from the troubled home, and if he or she can develop a talent, skill, or something that is valued by others in the social circle and community. Other factors that are protective against substance abuse and addiction are: community factors-a positive neighborhood, low levels of crime, adequate housing, and high rates of employment; family environment-adequate parental attention (especially during the first year of life), a nurturing family with appropriate structure, parents who encourage learning, and adequate household income; innate strengths-physically healthy, positive temperament and emotional well-being, and above-average intelligence; personality-flexible and adaptable, upbeat nature, self-disciplined, easygoing temperament, reasonable expectations, and good problem-solving skills.

132. How is the concept of resilience, from the perspective of mental health, BEST described? a. Internal strengths necessary to cope with challenging events b. Adequate resources to draw upon in times of emotional compromise c. Social networks that can offer support during times of distress d. Intellectual fund of information to reason and cope well with problems

132. A: The strengths that combine to produce resiliency include: (1) insight (asking essential questions, accepting honest answers, and thereby developing a mature understanding of self, others, and situations); (2) independence (balancing proper personal boundaries against the need for family bonds and affection and separating from the family if needed); (3) wholesome relationships (finding substitute parents or mentors, as needed, with balanced attachments); (4) initiative (able to accomplish goals and tasks from which is drawn proper self-esteem and a pleasure in achievement that promotes ongoing growth and development); (5) creativity or humor (imaginative creativity to make nothing into something positive); (6) humor (the ability to laugh at oneself and circumstances so as to turn something negative into nothing); and (7) morality (a well-informed conscience that serves and alleviates suffering in others). Fostering these strengths in children, youth, and adults can help them develop into highly resilient individuals.

133. Culture can play a significant role in substance abuse. How do Hispanic and Latino populations, in general, tend to respond to alcohol problems in the family? a. By lashing out and aggressively confronting the drinking problem b. By attempting to ignore and avoid discussing the drinking problem c. By seeking out authority figures to help them engage the drinking problem d. By seeking out religious leaders to help them engage the drinking problem

133. B: Consequently, this group tends to delay treatment, which leads to less care overall. Deference to parents and the need to sustain family pride are at times problematic variables. Religious ceremonies and traditional celebrations are central cultural components, and alcohol use is typically expected at such events. On average, 40 percent of this group report alcohol use, and 5 percent report illicit substance use, with the highest rates among Puerto Ricans and the lowest among Cubans. Spanish-language groups and counselors are important contributions to the treatment process. Locating Spanish-speaking twelve-step groups can also make a substantial difference to positive, long-term outcomes.

134. African Americans have a significant presence in the United States. What is the percentage of the population that identifies themselves as black? a. 8 percent b. 11 percent c. 13 percent d. 16 percent

134. C: However, the overall group is remarkably diverse, coming not only from Africa, but also from Bermuda, South America, the Caribbean, and Canada. While most U.S.-born African Americans have shared experiences in terms of institutionalized racism and a relatively recent history with segregation and a distant recognition of slavery, many foreign-born Africans who reside in America have remarkably different experiences. Many grew up in countries with a majority black population and governments made up mostly of blacks. On average, 34 percent of African Americans report using alcohol (compared with 40 percent of Hispanics and 51 percent of whites. Further, only 9 percent of African American youth reported alcohol use, compared with 16 percent or more among white and Hispanic populations. African American use of illicit substances is similar to that of whites (6 percent) but higher than among Hispanics (5 percent). Unmet treatment needs are at 25 percent (Hispanics are at 23 percent), which is twice that as among whites.

135. Native Americans (American Indians and Alaska natives) have distinct cultures, particularly among those living on reservations or trust lands. What percentage report alcohol use? a. 15 percent b. 25 percent c. 35 percent d. 20 percent

135. D: Alcohol-related deaths are over three times the national average. Among those between the ages of twelve and seventeen, illicit substance abuse was 22 percent-a rate higher and at younger ages than any other group. Although only 20 percent of Native American live on reservations or trust lands, issues of poverty and unemployment as well as a culture relatively tolerant of alcohol and substance use have contributed to these troubling figures. There are 562 separate tribal entities recognized by the Bureau of Indian Affairs, and thus generalizations should be avoided. A tendency to use native healing traditions to treat substance abuse has also created further complexity. Some tribes are making efforts to push for alcohol-free activities, and recognition of the need to address the problem is growing. Considerable further progress needs to be made, and culturally sensitive programs should figure prominently in these efforts.

136. The racial mix of the United States continues to shift substantially. What is the fastest-growing minority group in the nation? a. Hispanics and Latinos b. Asians and Pacific Islanders c. African Americans d. Native Americans

136. B: Currently, this group comprises some 4 percent of the total U.S. population and 25 percent of the total foreign-born population (nine of ten were born on foreign soil). The majority of this heterogeneous group (more than half) live in only three states (California, Hawaii, and New York). Approximately 28 percent of Asian and Pacific Islanders report alcohol use, though only 3 percent report the use of illicit substances. This is the lowest rate of illicit substance abuse among all groups. Further, only 7 percent of adolescents in this group report alcohol use, as compared with 16 percent or more among whites, Hispanic or Latino, and Native American youth. However, it should be noted that there is great variation among various Asian and Pacific Islander groups. For example, illicit substance abuse rates by selected intragroup members are: Chinese (1 percent), Asian Indians (2 percent), Japanese (5 percent), and Koreans (7 percent). Consequently, careful assessments will be required.

137. Sooner or later, all treatment programs end, and a discharge summary and continuing care plan will then be required. What is the key difference between a discharge summary and a continuing care plan? a. A discharge plan provides directions for further treatment, while the continuing care plan addresses the client's clinical presentation at discharge. b. A discharge plan provides an overview of treatment and outcomes, while the continuing care plan addresses aftercare options based on the client's response to treatment. c. A discharge plan provides a roster of prior professionals involved, while the continuing care plan proposes further professionals to engage in the treatment process. d. A discharge plan provides a theoretical orientation to a client's presentation, while a continuing care plan offers a model for further intervention.

137. B: A discharge summary encompasses: (1) client demographics and general profile; (2) symptoms at admission; (3) interventions provided and outcomes realized; (4) critical incidents that occurred and resolution processes for each; (5) treatment goal progress and obstacles to progress; and (6) recommendations for further treatment in light of all treatment program events and progress. A continuing care plan encompasses: (1) options based on client's successes and residual needs; (2) appropriate resource linkages (food, housing, education, family needs, and legal issues); and (3) schedules for group meetings, twelve-step programs, and counseling, as well as other interventions. The discharge summary depicts what was done, why, and outcomes, as well as future recommendations. A continuing care plan explores options, identifies resources of benefit, and serves to schedule and coordinate all aftercare meetings and services.

138. Tracking client progress longitudinally is important to measure progress and document program effectiveness. How often is client data typically reviewed? a. Annually b. Biannually c. Semiannually d. Quarterly

138. A: During the annual evaluation, two key elements of evaluation are process and outcome. Process follows: drug testing results, individual or group interventions offered (session attendance, topics covered, etc.), and treatment plan formulation rationale and modifications. Each area covered is eventually aggregated into a total agency intervention and success or efficacy scores. Outcome addresses primary program goals and the level of success realized for each. Key indices include: attainment and maintenance of sobriety, educational or vocational goals, progress in behavioral goals, and degrees of success in family and social goals. Documentation (or charting) involves recording treatment interventions, together with levels of success, challenges, and the type and rationale for any modifications in interventions, goals, and success measures. Current law prevents recording human immunodeficiency virus (HIV) status in a regular chart, and counselors should avoid recording information that might be used to penalize or harm a client, should law enforcement discover or obtain the record.

139. Ideally, a treatment plan should be developed with which of the following sets of people? a. A consultant and the primary counselor b. The primary counselor and an assigned treatment team member c. The counselor and the client together d. A program administrator and a consultant

139. C: The most effective and influential treatment plans are those designed by both the client and a counselor working in concert with each other. This approach provides optimal buy-in for the client and the greatest clarity for counseling staff. The treatment plan should include an action plan for recovery that covers the duration of time prior to the next treatment plan review. Once complete, both the client and counselor should signify their joint commitment by mutually affixing their dated signatures to the current plan. Following this, the document should be reviewed and signed by the supervisor and medical director. Updates to the treatment plan should be provided at any time that major changes occur in the client's progress, behavior, or motivations.

141. Fundamental ethical principles govern the addiction treatment process, especially in situations of medication-assisted treatment (MAT) for opioid addiction. What does the principle of nonmaleficence refer to? a. Preserving client autonomy b. Working to a client's benefit c. Doing no harm to a client d. Faithfully honoring commitments

141. C: The concept of nonmaleficence is an ethical principle drawn from the biomedical literature. It refers to the ancient medical tenant Primum Non Nocere (Latin: first, do no harm-i.e., never make a problem worse). Medication-assisted treatment of opioid addiction has been challenged as enlarging or at least perpetuating an addictive problem. However, given the serious risks of illicit opioid use, ethicists have dismissed these concerns. Other key ethical principles are: (2) beneficence-working for the benefit and well-being of all clients (e.g., proper diagnosis, evidence-based treatments, etc.); (3) autonomy-often referred to as self-determination, this principle emphasizes respect for client rights to make well-informed choices that meet their own desires and life goals (it assumes a client has been fully informed of all risks and benefits of available options, and properly understands them); (4) justice-requires treatment providers to act fairly, equally, and equitably, especially when resources are limited; and (5) fidelity-faithfulness in honoring commitments and obligations (not abandoning clients, making and supporting proper referrals, etc.).

142. The capacity to be empathetic is important in counseling. What must a counselor do when relating to clients over issues of their past? a. Avoid any kind of emotional connection that compromises objectivity. b. Avoid becoming overly drawn into the client's history and issues. c. Ensure total emersion in the client's issues to properly relate and understand. d. Ensure every detail of past pain and trauma is relieved and released.

142. B: While empathy is important, it is necessary to find balance in working with clients who have suffered considerable past trauma and abuse. Becoming overly drawn in can cause the counselor to lose objectivity, become inappropriately emotional (angry, vengeful, etc.), and miss the opportunities to help the client move through and past his or her painful history. This can be particularly problematic if the counselor shares a similar past, which may easily lend to over-involvement in the presenting issues. In like manner, it also important that the counselor not be too dispassionate and detached, failing to allow the client to emotionally vent and unburden him- or herself. Typically, however, it is not necessary for a client to be prodded into revealing his or her past in minute detail. Rather, proper disclosure to the level needed for understanding is all that is necessary. It is important for counselors not to assume abuse from every symptom. As abuse in common in substance abusers, it is easy to infer abuse where it didn't exist-especially with clients who are overly eager to please their counselor.

143. The counselor-client relationship can be very complex. What does the term transference refer to? a. Feelings from the client that the counselor uses to strengthen the relationship b. Feelings from the counselor that the client accepts to grow and improve c. Feelings from a past relationship that are projected onto the counselor d. Feelings from current relationships that are added to the counseling experience

143. C: Clients with a past history of abuse often have painful and difficult memories and feelings about relationships. In particular, abuse often occurred in close relationships where the client should have been safe and protected. As the therapeutic bond in counseling grows, emerging feelings of closeness and trust can often trigger the complex feelings of the past. In so doing, these painful past feelings may be projected onto the counselor, causing the relationship to deteriorate. Clients may cope by trying to avoid dealing with the past, or they may maneuver the counselor into interactive patterns that replicate the past (e.g., caretaker, abuser, neglector, etc.). Care should be used not be manipulated, however unintentionally, into a client's past relational roles. This is best accomplished by maintaining objectivity, avoiding being drawn into offered roles, and by dealing directly and openly with any transference issues that arise.

144. The therapeutic relationship can produce feelings that are challenging. What does the term countertransference refer to? a. Feelings from the client that are projected onto the counselor b. Feelings from the counselor that are projected onto the client c. Feelings that the client openly shares with the counselor d. Feelings from the counselor that are used to promote resolution

144. B: These feelings can arise out of the counselor's past, or they can emerge in reaction to transference issues brought into the counselor-client relationship by the client. Unhealthy countertransference occurs when unresolved problems and feelings are projected onto the client. Absent clear boundaries and careful self-awareness, the counselor can lose the objectivity necessary to meet the client's needs and understand emerging issues. Countertransference is not the same as reacting to clear presentations from the client (e.g., positively when the client is pleasant and responsive and negatively if the client has a difficult personality). Diligent self-awareness can help the counselor identify the source of feelings along with the nature of the feelings and can help the counselor better serve the client, who may be evoking similar feelings and many others. When client needs and countertransference run together, the counselor may open up past issues prematurely and thereby compromise the client's welfare.

145. Working with substance-abusing clients can result in a variety of emotive experiences. What does the term secondary trauma refer to? a. The overlay of emotional abuse in a physically abusive relationship b. The medical sequelae that may arise after years of emotional abuse c. Entering a relationship with abusive features like those experienced before d. Symptoms in the counselor emerging from high exposure to client traumas

145. D: Counselors working with substance abusers are often exposed to traumatic narratives from clients with extensive histories of abuse (especially parent to child) and life chaos. When unrelieved, these narratives can accumulate and lead to posttraumatic stress disorder (PTSD)-like symptoms in counselors-difficulty concentrating, diminished affect, irritability, troubling dreams, compromised sleep, intrusive thoughts, free-floating anxiety, and so on. Accompanying feelings of anger, fear, or helplessness are common. The result can be counselor numbness and detachment, unconsciously dismissing client feelings and traumas, or overinvestment with parent-like caregiving or even inappropriate efforts at problem solving, rescuing, and failing to guide the client to essential growth. In these situations, counselors must seek supportive supervision and guidance to overcome emotional burdens and problematic responses.

146. Substance-abusing clients can be clinically and personally challenging. Of what is compassion fatigue a key symptom? a. Counselor burnout b. Clients with high-abuse histories c. Counselor apathy d. Clients with multimodal issues

146. A: Working with substance abuse clients can expose counselors to high emotions, great volatility, emotionally traumatic narratives of abuse, and so on. Over time, counselors can develop symptoms of compassion fatigue, apathy, and discouragement. Left unchecked, such feelings can compromise the counselor's skills, erode relationships, and can lead to a greatly shortened professional career and diminished personal life success. To combat burnout, counselors should: (1) avoid working in isolation; (2) maintain close supervisory support; (3) look for debriefing opportunities; (4) carry a varied caseload to minimize overload in one emotional area; (5) avoid overload in the number of cases being seen; (6) keep personal and professional life separated; (7) take appropriate vacations and time off; and (8) consider attending a counselor support group. Psychotherapy can also help the counselor professionally and personally in such situations.

147. What does a treatment frame assist both the counselor and clients to establish and maintain? a. An effective theoretical orientation b. Healthy boundaries in treatment c. Shared meanings and definitions d. An effective treatment focus

147. B: Clients with dense abuse histories often have difficulty establishing boundaries and have intense needs for approval, affection, and nurturing. Counselors can easily fall into trying to meet these needs, even while finding the relationship expanding to the point of role overload. To avoid this, counselors need to establish a treatment frame that helps set up and maintain reasonable boundaries. Key features of the treatment frame include: (1) an awareness that overinvestment fosters client dependency; (2) an understanding that clients must take responsibility for their own lives to grow; (3) establishing appointment times and durations in advance to limit encroachment; (4) enforcing start and closing session times; (5) refraining from giving out one's home phone number; (6) canceling sessions if the client is intoxicated; (7) limiting all contacts to the therapy session; (8) preventing intimate (sexual) boundary misinterpretations; (9) terminating if threats or acts of violence are experienced; and (10) insisting on proper and timely payment of session fees.

148. Trust is an essential component of a productive counseling relationship. Which of the following is NOT a key counselor contribution to the development of trust? a. Unconditional positive regard b. Nonjudgmental attitudes c. Greater latitude in boundary setting d. Ongoing commitment to client success

148. C: Failing to set proper and consistent boundaries may initially appeal to a client, but uncertain boundaries will inevitably lead to client uncertainty, anxiety, and misunderstandings, which ultimately erode trust. Clients with troubled parent-child relationships often find themselves in other abusive relationships. As the experiences with these problematic relationships grow increasingly negative, such clients often become overly suspicious and distrusting of even therapeutic relationships. As the counselor remains consistent, committed, and balanced, especially in times of crisis, client trust will grow, and the client can begin experiencing and building the essential features needed for trusting relationships. Contributing greatly is the unconditional positive regard and nonjudgmental attitude the client experiences from the counselor.

149. Counselor-client relationships can at times become inappropriately intimate and intense. What is one particularly problematic potential from this? a. Client rejection of the counselor b. Client romantic feelings for a counselor c. Client apathy regarding a counselor d. Client feelings of anger toward a counselor

149. B: Clients with a history of substance abuse often have unmet developmental issues, along with issues of confused emotions due to substance influences and distortions due to histories of intimate abuse. Many are unfamiliar with virtually any trusting and caring relationship, having largely been subjected to relationships of shame, guilt, fear, and anger. As trust in the counselor grows, these feelings can easily be misinterpreted as feelings of romantic love for the counselor. This can be compounded when abstinence leads to a distorted substitution of fantasies and romantic thoughts for substance intoxication. In response, counselors must maintain impeccable boundaries, and consider: (1) addressing the feelings openly; (2) turning the client's feelings toward other nonsexual relationships; and (3) teaching the client to differentiate between feeling good and feeling sexual desire. To maintain safety and balance, it is important for counselors to disclose such situations to a trusted colleague in order to properly balance the situation and maintain safety.

150. Clients with a history of sexual abuse may have poor boundaries with others. If a counselor becomes sexually involved with a client, what are the consequences? a. Termination of employment b. Loss of licensure c. Potential prosecution d. All of the above

150. D: Every licensing body has ethical prohibitions against a counselor becoming sexually involved with a client. The likelihood of such an ethical breach being reported is very high, and the results inevitably lead to loss of employment and licensure. Further, many states have criminal statutes that would apply, and both civil and criminal prosecution are very likely. Most importantly, however, the damage done to the client can be profound when yet another meaningful relationship fails to be safe. A client's seductive behavior is no protection from this, as many see sexual favors as the only way they can earn or feel to deserve a positive relationship. Counselors must profoundly guard against such conduct. Many feel male counselors should not treat female sexual abuse victims, and a client preference in counselor gender should be honored. Where circumstances allow or require otherwise, however, a male counselor who maintains safety can provide a client with new positive male role model and thus help the client further along in recovery.

What is the case management model that seeks to identify clients' needs and assist clients in obtaining access various identified resources known as? a. Brokerage or Generalist Model b. Program of Assertive Community Treatment Model c. Strengths-Based Perspective d. Clinical or Rehabilitation Model

A: Brokerage or Generalist Model. This approach endeavors to evaluate and determine clients' needs in order to help them access specific resources. Client contacts are minimal, and planning is brief, as the goal is prompt and accurate referral without establishing an intensive, long-term relationship. Consequently, there is little to no monitoring or proactive advocacy. Because of this, the Brokerage or Generalist model is not always ideal, yet the limited relationship allows for cost-effective rendering of services to a greater numbers of clients. This approach works best when treatment and social services are well integrated, thus limiting the need for advocacy and monitoring. The optimal client is not economically deprived, has otherwise adequate resources, and is not in late-stage addiction. Smaller agencies that offer narrowly defined services may benefit most from this model. In some situations, case managers may also serve as educators, offering sessions on substance abuse and related high-risk behaviors.

How is the individual who is responsible to carry out the clinical monitoring and collaborative client assessments, evaluations, referrals, treatment coordination, and goodness-of-fit appraisals of the treatment plan to client goals and objectives BEST known as? a. Case manager b. Service coordinator c. Therapist d. Administrator

A: Case manager. This individual is the one most comprehensively responsible to evaluate, track, and coordinate the broad array of resources and services that a client is receiving in the treatment process. A service coordinator may assume some of these roles but is less involved in the clinical assessment and evaluation processes. A counselor or therapist may be very involved in clinical evaluations and assessments but would not typically be as involved in service coordination. Finally, an administrator looks after the management of a program or agency and thus would not typically be involved in frontline client evaluations and assessments or referrals and service coordination. Case management, however, addresses: assessment and evaluation (client capacity, progress and readiness, as well as agency, program, and resource availability and effectiveness), service coordination, referrals and referral network management, monitoring, tracking, problem solving, advocating, negotiating, offering liaison services, and arranging and carrying out the resource needs of a treatment plan.

How do the rates of heavy alcohol use among youth ages twelve to seventeen in rural areas compare? a. Double the rates in metropolitan areas b. Slightly higher than the rates in metropolitan areas c. About the same as the rates in metropolitan areas d. Half the rates found in metropolitan areas

A: Double the rates in metropolitan areas. The rate of alcohol use among adults over the age twenty-five is lower in rural areas than that found in metropolitan areas. However, youth between the ages of twelve and seventeen have rates of heavy alcohol use that are almost double those in metropolitan areas. Further, rates of alcohol use and alcoholism among women in rural areas are higher than rates among women in metropolitan areas. Even so, at least one study reveals that individuals living in urban settings were treated for substance abuse more than twice as often as those living in a rural setting. It was concluded that the stigma of substance abuse treatment and the availability of treatment combined to substantially limit the treatment rate. Given that 20 percent of the U.S. population lives outside of metropolitan areas, understanding the unique needs of rural populations is important.

What do studies indicate about lesbian, gay, bisexual, and transgender (LGBT) individuals? a. They are more likely to abuse alcohol and drugs than the general population. b. They are similar to the general population in their use of alcohol and drugs. c. They are more likely to use drugs but not more likely to use alcohol than others. d. They are less likely to abuse alcohol and drugs than the general population.

A: They are more likely to abuse alcohol and drugs than the general population. Because many research instruments do not ask about sexual orientation, very little reliable information is available on substance abuse among lesbian, gay, or bisexual (LGB) individuals. However, research does indicate that lesbian, gay, bisexual, and transsexual (LGBT) individuals use alcohol and drugs more often than the general population. They are also more likely than the general population to persist in drinking heavily into later life and less likely to stop using drugs. On average, members of the LGBT community also use more kinds of drugs, including those that more profoundly impair judgment, such as amyl nitrite (poppers), Ecstasy, ketamine (Special K), and gamma hydroxybutyrate. These drugs are frequently used at parties and raves, during and after which increased risky sexual behavior may lead to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) or hepatitis infections. Cultural groups differ in how they view their LGBT members. In Hispanic culture, matters of sexual orientation tend not to be discussed openly. LGB members of minority groups often find themselves targets of discrimination within their minority culture and of racism in the general culture.

Although homeless individuals are more likely to receive detoxification services than people not homeless, what percentage will receive full treatment for their alcohol or substance abuse problems? a. 15 percent b. 25 percent c. 35 percent d. 45 percent

B: 25 percent. In other words, 75 percent will not receive proper treatment. Although the homeless receive detox services more than three times as often as people who are not homeless (45 percent vs. 14 percent), this is likely due to unexpected hospitalizations, psychiatric facility transitioning, and vagrancy and drug possession arrests that result in an involuntary detox and loose medical supervision. Of the approximately six hundred thousand homeless at any given time, about 41 percent are white, 40 percent are African-American, 11 percent are Hispanic, and 8 percent are Native American—disproportionate minority representation. The homeless may be: (1) transient—temporarily with others and at high risk of suddenly being on the street; (2) recently displaced—due to eviction or other financial problems (potentially due to substance abuse; or (3) chronically homeless—often with severe substance use and mental disorders, they are difficult to draw into treatment and are in need of creative outreach and programming initiatives.

What is the case management model that integrates therapeutic and resource acquisition activities known as? a. Strengths-Based Perspective b. Clinical or Rehabilitation Model c. Brokerage or Generalist model d. Program of Assertive Community Treatment Model

B: Clinical or Rehabilitation Model. The case management clinical or rehabilitation approaches integrate clinical therapy and resource activities together. Both needs are met by the case manager rather than separate providers. Researchers have posited that it is not feasible or functional to divide these two activities for an extended time. To this end, the Clinical or Rehabilitation model merges these two activities by training case managers to see beyond solely environmental issues to other client-focused needs. To this end, the case manager is positioned to provide psychotherapeutic services, offer family therapy, and teach essential skills in a variety of areas, including relapse prevention, and so on. Beyond the usual repertoire of case management functions (assessment, planning, linkage, monitoring, and advocacy [per the Joint Commission on Accreditation of Healthcare Organizations] or assessing, arranging, coordinating, monitoring, evaluating, and advocacy [per the National Association of Social Workers]), the case manager should also address issues of transference, countertransference, client internalizations of observations, theories of ego functioning, and so on. In this way the client's needs can be met in a more holistic and integrated fashion, which should lead to enhanced outcomes.

A program or agency at times may require outside services to continue functioning properly. When an outside official or agency provides services solely to maintain the function and viability of a treating agency or program, confidentiality is maintained when service providers sign a a. Contractual Agreement for Limited Services (CALS). b. Qualified Service Organization Agreement (QSOA). c. Confidentiality and Privacy Service Agreement (CPSA). d. Consent and Disclosure Limitations Contract (CDLC).

B: Qualified Service Organization Agreement (QSOA). The use of a Qualified Service Organization Agreement (QSOA) is only indicated when an outside official or agency is providing services directly to a treatment program or agency itself. Any disclosure under the auspices of a QSOA is strictly limited to that information necessary for the service provider to ensure that the program or agency is able to function effectively. In turn, the QSOA stipulates that the service provider (i.e., the official or the contracted agency) is legally bound to resist any judicial proceedings seeking client information outside federal confidentiality standards and to maintain these same confidentiality standards in managing, processing, storing, and releasing any client information. In this way, the service provider is properly informed of relevant information to offer advice, consultations, and administrative insights necessary for the program or agency to efficiently and effectively carry out its necessary functions.

Homeless individuals are particularly susceptible to substance abuse due to the stress and hopelessness of their current situation. What are the three most common substances of abuse among this population? a. Alcohol, crack cocaine, and marijuana b. Alcohol, opioids, and marijuana c. Alcohol, opioids, and crack cocaine d. Alcohol, marijuana, and inhalants

C: Alcohol, opioids, and crack cocaine. Alcohol is the primary substance of abuse for 50 percent of the homeless admitted to treatment, with 18 percent abusing opioids (pain meds, heroin, etc.) and 17 percent abusing crack cocaine. Nearly one-quarter of the homeless (23 percent) have co-occurring disorders, while 20 percent of those not homeless also suffer with a co-occurring disorder. Recommendations for retaining homeless clients in treatment include: (1) meet their survival needs (food, clothing, warmth, and safe shelter) in addition to treatment and extensive continuing care; (2) optimally, early intensive treatment (clients attending 4.1 days per week have better outcomes than those attending fewer days); and (3) case management, which is needed to: (1) arrange safe and drug-free housing (which powerfully influences recovery, especially if housing is contingent on abstinence), (2) coordinate psychiatric and medical care, and (3) locate vocational training or education to help individuals become self-sufficient. The Alcohol Severity Index, the Alcohol Dependence Scale, and the personal history form have all been deemed valid and reliable screening tools for this population, especially when interviewed in a protected setting, with factual questions based on a recent time period.

Which is the ONLY case management model that specifically addresses making contact with clients in their homes and other natural settings? a. Clinical or Rehabilitation Model b. Strengths-Based Perspective c. Program of Assertive Community Treatment Model d. Brokerage or Generalist Model

C: Program of Assertive Community Treatment Model. Developed as a mental health treatment model, key elements of PACT include: (1) meeting clients in homes and other natural settings; (2) addressing practical daily problems; (3) advocating assertively; (4) limiting caseloads to ensure effectiveness; (5) regular client-case manager contacts; (6) caseloads shared by a team; and (7) long-term client services. First adapted for use with chronic alcoholics, the model deviated from a typical approach in two ways: (1) case managers used an enforced contact strategy to meet clients at home and in the field, and (2) the focus was on alleviating suffering rather than requiring a pledge of total abstinence. An adaptation of PACT, the Assertive Community Treatment (ACT) model is used to provide direct counseling and the skills needed to succeed in a community setting. Case managers provide crisis intervention, family consultation, and group facilitation—teaching about human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), work skills, and relapse prevention. As opposed to PACT, the ACT model is time limited, and extended abstinence and treatment completion is expected. ACT can be implemented alone or in concert with a therapeutic community.

How are the clinical, evaluative, and administrative activities that link clients with treatment, community services, and other resources needed to carry out a treatment plan MOST comprehensively referred to? a. Case management b. Client advocacy c. Service coordination d. Resource linkage

C: Service coordination. Both case management and client advocacy are subsets of service coordination, and resource linkage is one of the direct activities involved in each of these endeavors. Service coordination provides an action framework by which a client is enabled to achieve the specific goals identified in a treatment plan. It requires collaborative efforts not only between a case manager or counselor and a client but also with significant others as well as liaison activities with available agencies, service providers, managed care systems, and other community resources. Fundamental to service coordination is ongoing evaluation of client needs and treatment progress as well as resource referrals and advocacy as needed. The coordination and integration of treatment activities shared among various providers is a central feature of service coordination.

Among the numerous principles that are essential to effective case management, how is the principle of advocacy BEST described? a. Taking the client's side in situations of conflict b. Ensuring the client understands institutional rules c. Helping an institution to meet a client's desires d. Advocating for the client's best interests

D: Advocating for the client's best interests. The case manager's advocacy role is to identify and secure a client's best interests. This is involves a dual responsibility—advocating for a client's genuine needs to be met and holding clients accountable when necessary. There are times when an institution is overlooking its responsibilities or even failing to meet those duties ascribed to it by contract, law, or legislative policy, and so on. In such situations, the case manager must advocate for the services that should be provided to the client, even if it requires confronting the institution or agency. In like manner, there are times when a client is failing to meet responsibilities and must be held accountable. At such times, it may be necessary for the case manager to advocate for sanctions, reporting, or other exclusions in order to ensure the client recognizes the neglected responsibilities, compliance, or performances that are required.

What does the term cultural brokering refer to? a. Immigration and naturalization assistance b. Financial managers for ethnic and racial minorities c. Housing services for ethnic and racial minorities d. Liaison work between cultures to meet needs

D: Liaison work between cultures to meet needs. The culture brokering approach was conceived to mediate the difficult gap between the needs of foreign-born people and the U.S. health care system. This model can also help clients with disabilities and impairments. Almost one-sixth of all U.S. citizens have some functional disability. Of these, more than 30 percent live below the poverty line, and most expend considerable financial resources on their disability-related needs. The combination of depression, frequent pain, employment difficulties, and functional limitations leaves the cognitively and physically disabled vulnerable to substance abuse. Yet, research reveals, they are less likely to receive effective treatment than those without any disability. Further, many disabled (and other) individuals struggling with addiction have unidentified learning disabilities that can impair successful treatment. Even individuals with the same disability may differ in their functional capabilities and limits. Consequently, treatment providers must carefully assess these clients and tailor treatments to meet their unique needs.

What is the case management approach that focuses on helping clients assert direct and personal control in the search for resources? a. Program of Assertive Community Treatment Model b. Clinical or Rehabilitation model c. Brokerage or Generalist Model d. Strengths-Based Perspective

D: Strengths-Based Perspective. This approach was developed to assist those with persistent mental illness to transition from institutional care to independent living. Two foundational principles are: (1) assisting clients in assuming direct control over their own search for resources (e.g., transportation, housing, employment, etc.), and (2) drawing upon clients' strengths in the acquisition of resources. This model focuses on informal helping networks (rather than institutional networks), supported through the client-case manager relationship. To achieve goals, the case manager maintains an active client outreach. The strengths case management perspective is used with substance abusers for three reasons: (1) case management facilitates client responsibility in finding and accessing resources needed for an enduring recovery; (2) the advocacy component counters the belief that substance abusers are morally deficient or in denial and thus unworthy of support; and (3) the emphasis on client strengths, assets, and abilities counterbalances treatment models that emphasize pathology and disease. Advocacy and client-driven goal planning can at times cause stress between the case manager and other members of a treatment team, but the approach clearly leads to improved client outcomes.