Review the Learning Resources on ethics and substance use disorders.? Reflect on your own attitudes and opinions toward people with substance use disor

N A T I O N A L A S S O C I A T I O N O F S O C I A L W O R K E R S

Clients with Substance

Use Disorders

N A S W S t a n d a r d s f o r

S o c i a l Wo r k P r a c t i c e w i t h

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Clients with Substance

Use Disorders

N A S W S t a n d a r d s f o r

S o c i a l Wo r k P r a c t i c e w i t h

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National Association of Social Workers Jeane W. Anastas, PhD, LMSW President

Elizabeth J. Clark, PhD, ACSW, MPH Chief Executive Officer

Standards for Social Work Practice with Clients with Substance Use Disorders Work Group Maurice S. Fisher Sr., PhD, LCSW, LSATP, BCD Jessica Holton, MSW, LCSW, LCAS Katherine van Wormer, PhD, MSSW

NASW Staff Tracy R. Whitaker, DSW, ACSW Sharon S. Issurdatt, LICSW, LCSW-C

©2013 National Association of Social Workers. All Rights Reserved.

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Contents

5 Background

6 Guiding Principles

7 Shifting Trends

8 Goals of the Standards

10 Standards

10 Standard 1. Ethics and Values

11 Standard 2. Qualifications

12 Standard 3. Assessment

12 Standard 4. Intervention

13 Standard 5. Decision Making and Practice Evaluation

13 Standard 6. Record Keeping

14 Standard 7. Workload Management

14 Standard 8. Professional Development

15 Standard 9. Cultural Competence

16 Standard 10. Interdisciplinary Leadership and Collaboration

16 Standard 11. Advocacy

17 Standard 12. Collaboration

18 References

18 Resources

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Background

Social workers regularly encounter individuals, families, and communities affected by substance use disorders (SUDs). Many social workers specialize in the alcohol, tobacco, and other drugs field, whereas others provide services to individuals and their families in specialty and nonspecialty settings in which SUDs are often integral to the clients’ presenting problems. These settings can include health and mental health centers, hospitals, child welfare and aging services, courts and correctional facilities, employee assistance programs, and private practices.

There is a growing emphasis in the professional fields working with clients with SUDs on using short-term, limited interventions. However, many clients who are dependent on substances require longer term interventions that recognize that substance use can be a chronic disorder— one that includes relapse and may not resolve for months or even years.

Substance use disorders are often exhibited with co-occurring disorders—the use of more than one substance and/or one or more psychiatric disorders simultaneously. A co-occurring disorder may also be a medical condition. Clients with SUDs may also display polysubstance patterns, in which they experience physical or psychological effects from more than one substance. In the field of addiction treatment, there is recognition that addictive behaviors may be linked and that treatment for substance use disorders and other addictive behaviors (for example, gambling, overeating) may overlap.

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Social work practice is in a unique position to influence the delivery of services by addressing the acute and chronic needs of clients with SUDs, including co-occurring disorders and polysubstance patterns. By developing and applying evidence-informed approaches that incorporate established interventions and evolving techniques based on emerging research findings, social workers can markedly improve treatment services for clients and their families. This approach to service delivery requires that social workers be knowledgeable about the processes and dynamics of substance use, including abuse, dependency, and recovery. Social workers also need to have the knowledge and ability to work with clients to develop effective treatment plans using existing and emerging resources, including evidence-informed practices.

Guiding Principles

There are many pathways to treatment and recovery. Viewing the client as part of a larger system while providing individualized treatment, as appropriate, is a mainstay of delivery of effective services. Given the extensive social stigma and common misperceptions related to substance use disorders, diagnosis and/or treatment can affect a client’s professional status, social standing, and livelihood. Substance use disorders can also significantly disrupt a client’s family system. Understanding the implications of SUDs with regard to parenting abilities and the resulting consequences for children involved is a key factor to be considered.

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Social work practice encompasses a supportive approach and is aligned with the core values of the social work profession. Social work practice values the importance of education, early intervention, and prevention of substance use disorders.

To meet the needs of clients with substance use disorders, social workers must remain current regarding the frequent changes in legislation, regulations, and third-party payer requirements (including the Patient Protection and Affordable Care Act [P.L. 111-148], more commonly known as the “Affordable Care Act,” and the Health Insurance Portability and Accountability Act of 1996 [P.L. 110-199]), known as HIPAA.

Shifting Trends

Consistent with a change in conceptualization in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM–5) (see American Psychiatric Association, 2012), addiction is no longer viewed as an “either/or” phenomenon. That is, substance use is no longer dichotomized into separate categories of dependence and abuse; rather, is viewed as existing along a continuum. This paradigm shift opens up the possibility for larger numbers of clients meeting the criteria of having substance use disorders and being eligible for treatment. For assessment purposes, social workers shall be familiar with the criteria for assessment of substance use disorders in the DSM–5.

Related to this shift, harm reduction is increasingly emphasized today in federal funding and treatment services. The harm

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reduction approach is consistent with the social work value of self-determination and “meeting the client where the client is.” Harm reduction principles are applied in the interests of promoting public health—for example, to reduce homelessness or prevent the contraction of HIV/AIDS in populations affected by substance use disorders.

Related to the social work core value of competence as well as to principles of harm reduction, practices should be evidence informed when research findings are available. The use of evidence-informed practices for treatment is required by many third-party payers. When working with clients with substance use disorders, it is important to explore all relevant methods of treatment and clients’ levels of motivation in developing appropriate treatment interventions.

For clients with co-occurring disorders and polysubstance patterns, the treatment field is shifting to a more holistic approach through integrated treatment. Social workers will need to have the knowledge and skills to provide treatment for substance use disorders and additional co-occurring mental health disorders simultaneously.

Goals of the Standards

These standards were developed to broadly define the scope of services that social workers shall provide to clients with substance use disorders, that clients and their families should expect, and that program administrators should support. The standards are designed to enhance

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awareness of the skills, knowledge, values, methods, and sensitivities that social workers need to work effectively within systems dedicated to serving clients with substance use disorders. Ideally, these standards will stimulate the development of clear guidelines, goals, and objectives related to social work services in social work practice, research, policy, and education. The specific goals of the standards are to

n establish expectations for social work practices and services with clients with substance use disorders

n ensure that social work practice with clients with substance use disorders is guided by the NASW Code of Ethics

n ensure that the highest quality of social work services are provided to clients with substance use disorders and their families

n provide a basis for advocating for clients’ rights to be treated with respect and dignity, have their confidentiality protected, have access to supportive services, and have appropriate inclusion in decision making

n provide a basis for the preparation of social workers and the development of continuing education materials and programs related to social work services with clients with substance use disorders

n encourage social workers providing services to clients with substance use disorders to participate in the development and refinement of public policy at the local, state, and federal levels to support client success.

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Standards for Professional Practice

Standard 1. Ethics and Values

Social workers working with clients with

substance use disorders shall adhere to the

ethics and values of the social work profession

and shall use the NASW Code of Ethics as a

guide to ethical decision making, while

understanding the unique aspects of social

work practice with clients with substance

use disorders and the needs of clients and

their families.

Interpretation

Social workers shall demonstrate core values of service, social justice, the dignity and worth of the person, the importance of human relationships, integrity, and competence. In addition, social workers shall adhere to the professional ethical responsibilities delineated in the NASW Code of Ethics.

Social workers shall have knowledge of and comply with local, state, and federal mandates related to informed consent, privacy and confidentiality, and access to records in the context of legal and ethical rights of adults, minors, and their parents. Clients, their families, and other professionals shall be informed of the limits of confidentiality when services are initiated. Employers and administrators should be informed of the ethical responsibilities of the social work profession. In the event that conflicts arise among competing expectations, social workers are directed to the NASW Code of Ethics as a tool in their decision making.

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Standard 2. Qualifications

Social workers shall meet the provisions for

professional practice set by NASW and related

state and federal laws while possessing

knowledge and understanding basic to the

social work profession with regard to

professional practice with clients with

substance use disorders.

Interpretation

Social workers shall have a degree in social work from a program accredited by the Council on Social Work Education. An MSW degree is the recommended qualification for a social worker to provide clinical services. Working with clients with substance use disorders is a distinct specialty and scope of practice within the social work profession. Social workers working with clients with substance use disorders shall possess specialized knowledge and understanding of psychological and emotional factors, physiological issues, diagnostic criteria, legal considerations, and co-occurrence of mental health disorders and substance use. This knowledge shall include an understanding of family dynamics, the effects that SUDs have on parenting abilities, and the resulting consequences for children. Social workers shall also be knowledgeable about current evidence- informed approaches and best practices for service provision to clients with substance use disorders. Social workers shall actively seek to remain current with specialized training, as appropriate. Social workers shall be certified and/or licensed by state boards of social work when appropriate.

Social workers shall remain current regarding changes in legislation, mandates, and regulations

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on federal, state, and local levels. Social workers shall also remain current regarding laws and regulations pertaining to HIPAA and third-party payers.

Standard 3. Assessment

Social workers shall conduct ongoing

assessments of clients to provide clients with

substance use disorders with appropriate

diagnoses and treatment plans.

Interpretation

Social workers shall possess skills in systematic assessment, data gathering, and interpretation at multiple levels and use a variety of methods (for example, interviews, direct observations, standardized instruments, surveys) to assess the needs, characteristics, and interactions of clients with substance use disorders. Social workers shall conduct reliable and valid assessments of clients to inform the design of interventions for treatment. Assessments shall use biopsychosocial perspectives and functional approaches to enhance an understanding of the complexity of aspects related to substance use.

Standard 4. Intervention

Social workers shall be knowledgeable of and

incorporate information based on assessment

and evidence-informed practices in their

interventions.

Interpretation

Social workers shall demonstrate competency in and remain current with intervention research and use evidence-informed practices in service delivery with clients with substance use disorders. Interventions shall be designed to fulfill the treatment plan within the framework

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of the client being served. Interventions shall be based on assessments relevant to the presenting concerns and include goals, objectives, methods of evaluation, and outcome criteria. Interventions shall address the aspects most relevant to the problem being addressed.

Standard 5. Decision Making and Practice

Evaluation

Social workers shall use data to guide service

delivery and to evaluate their practice regularly

to improve and expand client services.

Interpretation

Social workers shall collect, analyze, synthesize, and disseminate data related to their practice with clients with substance use disorders. Social workers shall conduct ongoing evaluations to determine the level of effectiveness of all interventions. Methods used to evaluate social work practices shall be assessed periodically to ensure that objectives, activities, and measured outcomes are aligned with the client, service agency goals, and ethical social work practice.

Standard 6. Record Keeping

Social workers shall maintain appropriate and

accurate data and records that are relevant

to planning, implementation, and evaluation

of social work services, in accordance with

professional ethics and local, state, and

federal mandates.

Interpretation

Social workers shall maintain timely, accurate, and confidential records that document social work services, demonstrate outcomes, and promote accountability. Social workers shall comply with applicable regulations regarding

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client records. Records shall be maintained according to federal, state, and local laws. Ethical considerations shall be guided by the NASW Code of Ethics.

Standard 7. Workload Management

Social workers shall organize their workloads

so as to fulfill their responsibilities and clarify

their critical roles while providing services to

clients with substance use disorders.

Interpretation

Social workers shall manage their work in an efficient and effective manner. Priorities for practice shall be developed collaboratively between the social worker providing direct services and the supervisor and/or agency, when appropriate. Priorities shall be established on the basis of the needs of clients, professional skills of the social worker, program needs, research, and availability of other resources. Social workers working with clients with substance use disorders shall perform roles and fulfill responsibilities within the current framework for best practices in the field and use technology to enhance communication, obtain and organize information, demonstrate accountability, and complete workload assignments as appropriate.

Standard 8. Professional Development

Social workers shall pursue continuous

enhancement of knowledge and skills to

provide the most current, beneficial, and

culturally appropriate services to clients with

substance use disorders and their families.

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Interpretation

Social workers shall adhere to the NASW Standards for Continuing Professional Education (2003) and follow state licensing requirements regarding continuing education requirements. Social workers shall access ongoing supervision and consultation to increase their professional proficiency and competence. Social workers practicing with clients with substance use disorders shall participate in professional development activities that enhance their knowledge and skills relevant to the population they serve. Social workers shall also contribute to the development of the profession by educating and supervising social work interns when possible.

Standard 9. Cultural Competence

Social workers shall ensure that all clients

and their families are provided with services

within a context of cultural understanding

and competence.

Interpretation

Social workers shall demonstrate self-awareness, knowledge, and practice skills consistent with the NASW Standards for Cultural Competence in Social Work Practice (2001). Social workers shall continue to develop specialized knowledge and understanding about clients they serve and culturally appropriate resources. This understanding shall be applied in a manner resulting in a positive treatment environment that respects and values differences. Social workers shall use evidence-informed practices, skills, and techniques that reflect their understanding of the role of culture in the

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helping process. Social workers shall recognize influences of cultural issues relating to substance use within the client’s life.

Standard 10. Interdisciplinary Leadership

and Collaboration

Social workers shall provide leadership in

developing positive treatment environments,

supervision of other professionals,

administrative direction, and research and

treatment relating to substance use disorders.

Interpretation

Social workers shall serve as leaders and consultants in the field of substance use disorders and the profession of social work through guidance of treatment, policy advocacy, and participation in research. Social workers shall provide training and education to families, the community, and other professionals relating to the aspects of substance use and related risks and treatment modalities when appropriate. Social workers shall also provide leadership and collaboration in the development and implementation of comprehensive programs to benefit those affected by substance use as well as the community. When possible, experienced social workers shall consider offering consultation and supervision to other professionals in the practice field.

Standard 11. Advocacy

Social workers shall engage in advocacy that

seeks to ensure that clients with substance use

disorders and their families have equal access

to the appropriate services in a timely manner.

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Interpretation

Social workers shall advocate for clients and their families. This advocacy shall include helping clients and their families gain access to and effectively use formal and informal community resources that foster self-advocacy. Social workers shall seek to be informed about court decisions, legislation, rules and regulations, and policies and procedures that affect social work practice with clients with substance use disorders.

Standard 12. Collaboration

Social workers shall promote interdisciplinary

and interorganizational collaboration to

support, enhance, and deliver effective

services to clients with substance use

disorders and their families.

Interpretation

Multiple service providers often serve clients with substance use disorders. Social workers shall understand the roles and goals of other professionals and work toward effective collaboration and understanding. Such collaboration can include multidisciplinary teams, medical providers, community leaders, law enforcement officials, child welfare workers, and other service providers. Collaborations can ensure that clients with substance use disorders receive coordinated care so as to avoid duplication of services and ensure client needs are met.

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References

American Psychiatric Association. (2012). DSM–5 development: R substance use disorder. Retrieved from http://www.dsm5.org/proposed revision/pages/proposedrevision.aspx?rid=431

Health Insurance Portability and Accountability Act of 1996, P.L. 104-199, 110 Stat. 1936 (1996).

National Association of Social Workers. (2001). NASW standards for cultural competence in social work practice. Washington, DC: NASW Press.

National Association of Social Workers. (2003). NASW standards for continuing professional education. Washington, DC: NASW Press.

National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Washington, DC: NASW Press.

Patient Protection and Affordable Care Act, P.L. 111-148, 124 Stat. 1025 (2010).

Resources

NASW Code of Ethics (2008) The NASW Code of Ethics is intended to serve as a guide to the everyday professional conduct of social workers.

NASW Standards for Continuing Professional Education (2003) These standards provide guidance to social workers who want to match their continuing education activities with professional expectations. The standards also serve as a resource to assist social workers in the selection and provision of continuing education.

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NASW Standards for Cultural Competence in Social Work Practice (2001) These standards address the need for definition, support, and encouragement of the development of high-level social work practices that encourage cultural competence among all social workers to respond effectively, knowledgeably, sensitively, and skillfully to the diversity inherent in the agencies in which they work and with the clients and communities they serve.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) The HIPAA privacy rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information (see http://www.hhs.gov/ocr/privacy/hipaa/ understanding/index.html).

Patient Protection and Affordable Care Act More commonly known as the “Affordable Care Act,” this legislation puts in place strong consumer protections, provides new coverage options, and gives consumers tools needed to make informed choices about health (http://www.healthcare.gov/law/index.html).

Substance Abuse Mental Health Services Administration’s National Registry of Evidence- based Programs and Practices (NREPP) NREPP is a searchable online registry of more than 240 interventions supporting mental health promotion, substance abuse prevention, and mental health and substance abuse treatment. This registry connects members of the public to intervention developers to further implementation of these approaches in communities (http://www.nrepp.samhsa.gov).

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NATIONAL ASSOCIATION

OF SOCIAL WORKERS

750 First Street, NE

Suite 700

Washington, DC 20002-4241

202.408.8600

SocialWorkers.org

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Short Understanding of Substance Abuse Scale

PsycTESTS Citation: Humphreys, K., Greenbaum, M. A., Noke, J. M., & Finney, J. W. (1996). Short Understanding of Substance Abuse Scale [Database record]. Retrieved from PsycTESTS. doi: https://dx.doi.org/10.1037/t02615-000

Instrument Type: Rating Scale

Test Format: Respondents rated 19 items from 1 (strongly disagree) to 5 (strongly agree). To make scale scores more intuitively meaningful (i.e., so that complete disagreement with a model resulted in a score of zero, and strong endorsement was scored as four), responses were recoded by subtracting one from each response.

Source: Humphreys, Keith, Greenbaum, Mark A., Noke, Jennifer M., & Finney, John W. (1996). Reliability, validity, and normative data for a short version of the Understanding of Alcoholism Scale. Psychology of Addictive Behaviors, Vol 10(1), 38-44. doi: https://dx.doi.org/10.1037/0893-164X.10.1.38

Permissions: Test content may be reproduced and used for non-commercial research and educational purposes without seeking written permission. D

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