Prueba de hipótesis

collaborations will

ensurehigh-quality

referrals,effective

outreach, and

meaningful part-

nerships with com-

munity resources.

bringstheresponsi- bilitiesandexpecta- tionsforthecoun- selorstoamuch higherlevel.

Counselorsandstaff willbeexpectedto knowmore,explain nuancestofamily members, and incor- porateanynewfamily programactivities intotheirgeneral styleandtreatment approach.Forthis leveloffamily

participation,substanceabusecounselorswill requiresignificanttrainingandsupervision. Theprofessionalassociationsofstaffmembers mayofferguidanceintermsofsuggestedor requiredbackgroundortrainingtomeet acceptablestandards;and,ofcourse,

organizationsthattraditionallyincludefamily therapymodalitiesusuallyhavestandard curriculaandtrainingrequirementsthatthey promote.

Provider

Collaboration

Collaborationgoesbeyondreferral;itindicates thatthesubstanceabusetreatmentprogram andthefamilysocialserviceagencyhave establishedanongoingrelationshipsothatthe treatmentthattakesplaceatoneprovider agencyiscommunicatedtoandinfluencesthe courseoftreatmentorservicesattheother. Suchprovidercollaborationswillensure high-qualityreferrals,effectiveoutreach,and meaningfulpartnershipswithcommunity resources.Suchrelationshipsshouldencourage familyparticipationinbothsubstanceabuse andfamily-orientedservices.Ofcourse,deter- miningwhatafamilyneedsisadecisiontobe madeinthefamilyandnotbythesubstance abusetreatmentprovider.Fromthisperspective, theproviderencouragesempowermentwithin families to determine their own direction. Giventhecomplexitiesofinformedconsentand confidentialitythatarisefromaddingfamily educationtoaprogram’sofferings,developing collaborativerelationshipswithfamilytherapy andrelatedagenciesisnoeasytask.Staff memberswillbecalledontobeknowledgeable aboutfamily-involvedtreatmentmodelsand servicesandbefamiliarwithcommunity resources.Matchingtheresourcesofvarious providerswithafamily’sneedsandproviding thefamilywithinformationabouttheprosand consofvariousalternativeswillrequirea strongcommunityperspectiveandresource commitmentonthepartofthesubstanceabuse treatmentagency.

Issues for substance

abuse treatment program

administrators

Resourcesneedtobeprovidedtomonitorand ensurethathigh-qualityreferrals,outreach, andpartnershipcomponentsareinplace withintheagencyandcommunity.Examples ofsuchresourcesinclude

•Familyeducationsessionswherefamiliescan learnmoreaboutsubstanceabuseandfamily involvement.

•Acomprehensivereferralsystemthatcan facilitatetheparticipationoffamiliesand clientsintreatment-based,familytherapeutic activities.

•Expandedinformedconsent,whichwilloften benecessary.

•Clientandfamilyeducationaboutboththe benefits and challenges of using any particular providerorservice,andclientsshould understandtherelationshipsamongservice systems.Inaddition,programadministrators mayneedtodevelop“disclaimers”forclients sotheyunderstandthatasubstanceabuse treatmentagencycannotberesponsiblefor theactionsofanotheragency’sstafforpolicies. Formanyprovidercollaborationarrangements amemorandumofunderstanding(MOU)can bedevelopedtohelpclarifyandguidethe interrelationships.Coordinatedeffortsinclude activeinvolvementofsubstanceabusestaffin thetherapeuticprocessandcontinuouscontact withthefamilytherapistattheexternalagency. Detailed understanding of each other’s processes andprotocols,aswellasdetailedMOUs,can avoidredundanciesandimprovequality—for example,ifeachprogramscreensformental healthissues,coordinatingthescreening processeswillavoidduplicationandunneces- saryconfusiononthepartofclients,especially ifthedifferentscreeningapproacheswereto yielddifferentresults.Anotherexampleishow theMOUestablishesseparateresponsibilities foron-callserviceprovisionandresponsesto crises.

Toensureadequatecommunicationflowto meetthechallengesofcoordinatingprovider activities,programadministratorsfaceallocating personnelresourcesforavarietyoftasks,from documentationandinformationcoordination tojointpublicspeakingandpresentations. Someonecouldbedesignatedastheprovider collaborationcoordinator—perhapsaspartof qualityassurancedutiesorapositionthat implements,monitors,evaluates,supervises, updates,andeducatesstaffabouttherelation- shipswithotherproviders.Staffcouldbe assigneddutiesrelatedtocross-trainingefforts andparticipateineachother’sboards,

committees,ormultiagencyefforts.

Programadministratorswouldalsohaveto considerothercostsandthetaxingofresources bytheresponsibilitiesofcollaboratingwith otherproviders.Confidentialityandinformed consentwillberepetitiveissues,whetheritis howtomanagegroupformsoftreatmentinthe otheragencyorhowtoaddresstheHealth InsurancePortabilityandAccountabilityAct (HIPAA)requirements(formoreinformation onHIPAAseethefollowingWebsite:

http://www.hhs.gov/ocr/hipaa).Additionalcon- siderationsmightincludepoliciesfornon- clientsonthetreatmentpremises,spaceconsid- erations,security,insuranceissuestobesure thatone’sliabilityprotectionremainssecure, aswellasreimbursementissues.

Evaluationandoutcomemeasurementremain challengesforadministrators;yet,provider collaborationmightofferopportunitiestouse instrumentsdevelopedbyotherproviders,gain feedbackfromotherprofessionals,andoffer clientsachancetoexpressthemselvestoaneu- tralpartybyhavingoneagencysurveyclients abouttheclient’sviewsoftheotheragencies. Supervisorsfromeachagencyarelikelytobe interested in the views of each other’s personnel. Thefollowingevaluativequestionscanbe askedinanyoutcomescenariothatinvolves referringfamiliestootheragencies:

•Whatfamilymembersareactuallygoingto theotheragencytowhichtheywere referred?

•Whatdoesthefamilylikeaboutgoingtothe otheragency?

•Whataspectsoftreatmentfromtheother agencyarehelpful?

•Whatdoestheotheragencyprovidethatthis agencyalsoprovides?

Issues for staff and trainers

Staffinbothagenciescanexpandtheir knowledgeaboutsubstanceabuseeducation andfamilyresourcesinthecommunity.Staff membersshouldbeinformedaboutfamily- involvedtreatmentmodelsandprovideinfor- mationusingcollateralresourcestobuildtrust withfamilymembers.Supervisorsarelikelyto becalledontohelpstaffaccommodatethe changesandnewinformationgeneratedby