What VR counselors need to know about Substance Use Disorders Margaret Glenn and Joseph E.Keferl RRTC project funded by National Institute on Disability and Rehabilitation Research and National Center for Dissemination of Disability Research

Background RRTC project RRTC project Substance Abuse in Vocational Rehabilitation – Screener (SAVR-S) Substance Abuse in Vocational Rehabilitation – Screener (SAVR-S) Evaluation component Evaluation component

Why screen? Percentage of people with substance use disorders in VR system Percentage of people with substance use disorders in VR system

Table 1. % VR clients with either a primary or secondary substance use disorder diagnosis by state in 2005 Deciles States and Percentage of SUD as official diagnosis AR (0.90) OH (2.57) WV (3.58) TN (3.70) IN (3.72) IL (4.02) FL (4.04) AZ (4.35) ME (4.67) WI (4.72) NH (5.46) IA (6.09) RI (6.68) NE (6.80) CO (6.80) GA (6.89) OK (7.16) MT (7.36) SD (7.56) KA (7.78) NV (8.57) WY (9.24) DE (9.41) CT (9.64) OR (10.01) WA (10.46) MN (10.53) MO (10.69) NC (10.81) MS (10.88) VT (11.37) VA (11.61) CA (11.65) LA (12.16) AL (12.19) TX (12.33) NM (13.56) KY (14.87) MI (14.94) ID (15.46) AK (15.58) PA (15.66) UT (15.83) NJ (16.04) ND (16.14) MD (18.42) MA (19.85) NY (22.80) HI (26.94) SC (28.32)

Health implications Health implications Barriers to success in VR Barriers to success in VR Most importantly for… the client

O LIFE O SAVR-S

Drug free workplace policies Drug free workplace policies Screening practices Screening practices Barriers to success in employment Barriers to success in employment …the employers

…and for the counselor Derails goals & plans Derails goals & plans Depletes resources Depletes resources Decreases positive outcomes Decreases positive outcomes Impacts evaluation of their work Impacts evaluation of their work Need a process for screening Need a process for screening

Target population for training Vocational rehabilitation counselor Vocational rehabilitation counselor Field supervisors Field supervisors

Training Intervention Short format Short format Learning objectives Learning objectives 1.Understand goals of screening research project 2.Be able to communicate how project will support successful VR outcomes 3.Review agency’s policy regarding serving people with substance use disorders 4.Understand strengths & limitations of substance abuse screening & how to use/ interpret screening results 5.Develop an action plan for implementing the screening project

Data Collection Initial interviews Initial interviews Pre & Post surveys Pre & Post surveys Trainer debriefings Trainer debriefings

Pre/Post Perception Understanding of goal of screening Ability to communicate Ability to communicate Ability to discuss policy Ability to discuss policy Understanding strengths & limitations Understanding strengths & limitations Understand how to use results Understand how to use results Readiness to act Readiness to act

Open ended What is the goal of substance use disorder screening? What is the goal of substance use disorder screening? How will you go about doing screening in your VR work? Where will you start? How will you go about doing screening in your VR work? Where will you start? What procedural/ethical/issues arise in implementing this effort in your system? What procedural/ethical/issues arise in implementing this effort in your system? What resources do you have or need to implement this effort? What will be provided as support? What resources do you have or need to implement this effort? What will be provided as support?

Perceptions Vocational Rehabilitation Counselors n = 464

What knowledge or skills do you feel you are missing re screening Majority unaware of SUD screening effort Unfamiliar/lack of exposure Lack of knowledge of VR policies

What is the goal/purpose of substance use screening in VR? Identify if problem exists in VR consumers Identify if problem exists in VR consumers Improving service Improving service –Identifying/addressing obstacles –Improve outcomes Identify if a problem exists Identify if a problem exists Better assist consumers to improve employment outcomes Better assist consumers to improve employment outcomes

How/when to screen? Ask the person – beginning of service Formal assessment–psychological or vocational Refer out to qualified professional After workshop – –Employ screening early Intake or initial interview – –Use SAVR-S

What are the procedural, ethical, &/or legal issues of SUD screening Person’s right to privacy Person’s right to privacy Confidentiality Confidentiality How counselor/agency uses screening information How counselor/agency uses screening information

What resources do you need? Resources Resources –Need for technical support –Online &/or website for resources and information

Now to the interesting part

Borrowing from Mark Twain It is not what he doesn’t know that worries me so, it’s what he knows that just ain’t so! It is not what he doesn’t know that worries me so, it’s what he knows that just ain’t so!

What VR Needs To Know: What They Don’t Know They Don’t Know About Substance Use Disorders Need new presentation title!

Interpretation/Hypothesis Support need for additional training/investigation Support need for additional training/investigation –Use/administration/timing of screening for SUD –“It’s positive, what next” scenario –Interpretation/understanding of SUD & barriers to employment –Incorporating screening info into employment planning –Understanding agency policy surrounding SUD –Developing linkages/resources with formal tx providers –Navigating attitudinal issues –Addressing concerns impact on counseling relationship impact on counseling relationship confidentiality confidentiality

Screening for substance abuse barriers to successful vocational rehabilitation outcomes (2 CEUs) Determining eligibility for services (2 CEUs) Delivering services to ensure successful VR outcomes (2 CEUs) Addressing job development & placement (2 CEUs)

On the horizon… VR Counselors Desk Reference VR Counselors Desk Reference Administrators’ supplement Administrators’ supplement

For Educators… E-paks E-paks –Material for rehabilitation courses Psychological aspects Psychological aspects Medical aspects Medical aspects Counseling Counseling Career development & job placement Career development & job placement Case management Case management

In the end…

Questions?