016.20.98 Ark. Code R. 040
Background
As we begin to deal with the "Hard to employ" TEA recipients, there is a need to be able to identify recipients who potentially need alcohol or substance abuse treatment. In order for us to insure that individuals are receiving appropriate services, a procedure has been developed for the county office to use to help identify TEA recipients who may be in need of alcohol or substance abuse treatment. As part of those procedures, the DCO-1402 and DCO-181 have been revised.
Screening Tool - CAGE
In coordination with the Arkansas Department of Health - Bureau of Alcohol and Drug Abuse Prevention program, it has been decided that DCO will use the CAGE questionnaire as our screening tool. CAGE is a brief alcoholism/drug screening questionnaire asking subjects about attempts to Cut down on drinking and taking drugs, Annoyance over others' criticism of the subject's drinking, Guilt related to drinking, and use of an alcoholic drink as an Eye opener. The CAGE questionnaire consists of eight (8) questions that are answered by the recipient. It must be emphasized that the CAGE is simply a screening tool to help identify persons who may be in need of substance abuse treatment. It does not identify those who are in need of services. Only an assessment/evaluation conducted by a service provider can clearly identify a person who needs treatment. Therefore, it is important for county staff to recognize that when a referral is made to a service provider based on the CAGE questionnaire and/or other information, it is not a referral for treatment but only for an in-depth assessment/evaluation. As part of the assessment and update process, the screening tool and in-depth substance abuse assessment will be mandatory activities for recipients whom the Worker has determine are in need of such services.
The CAGE questionnaire has been incorporated into the revised DCO-1402. (Please see Section III of the attached revised DCO-1402.) For new TEA recipients that have not been screened, the CAGE will be administered during the assessment process while ongoing cases should be screened (recipient will complete revised DCO-1402) during the next scheduled Employment Plan Update. It should be noted that as a result of these changes, the DCO-1402 will no longer be an optional form but will be required.
In addition to the eight (8) screening questions from the CAGE questionnaire, the attached desk guide that lists observations/warning signs should further help workers to identify recipients with possible substance abuse problems.
SUBSTANCE ABUSE OBSERVATIONS and WARNING SIGNS
If an individual answers yes to any two of the eight (8) CAGE questions, or if the worker observes any of the observations/warning signs listed above, an in-depth substance abuse assessment may be appropriate. However, we suggest that the worker follow up with more in-depth questioning before making the referral. For example, a client may have already had treatment for a previous problem but he answered yes to the CAGE questions. However, he does not have a current problem and therefore, does not need an assessment. The worker may also receive information from household members who are aware of the substance abuse situation. If the worker feels comfortable with the information that has been received/ obtained, and the information appears to be pointing toward a substance abuse problem, then a referral for substance abuse assessment would be appropriate.
Failure of the recipient to complete the drug screening and/or referral for an in-depth assessment could result in sanctions procedures being implemented.
Revised DCO-1402 & DCO-181
Since the DCO-1402 will now be a required form for all applicants or recipients, it was decided to incorporate the Skills Assessment information from the DCO-181 into the DCO-1402 (Section II). This eliminates any duplication that may have existed between the two forms.
The DCO-181 will now be just the Employment Plan. The entire format of the DCO-181 has been revised. The worker may now list comments along the side of the tasks/activities. In addition a Signature Page has been added for both the recipient and worker to sign, stating they are in agreement with the activities listed on the Employment Plan. A copy of the revised form is attached.
Referral for Substance Abuse Assessment/Evaluation
NOTE: Before making a referral, the local DHS office should meet with the local provider of service to work out coordination, referral procedures, release of information, provision of services, etc. Referral to a substance abuse provider should only be made after the worker has received positive responses from the CAGE and/or the worker has observed warning signs and conducted follow-up questions with the recipient and/or members of the family. Referral for an in-depth substance abuse assessment should only occur if the previous steps taken indicate a possibility of substance abuse exists.
Referral for substance abuse assessment/evaluation is a continuation of the Employability Assessment process. The worker will inform the recipient that based on the results of the answers given and/or from their observations, they are being referred for a substance abuse assessment to determine if they could benefit from treatment. The worker should also inform the recipient that failure to complete the referral, without good cause, could be considered non-compliance with the assessment process.
The worker may use the DCO-3350, DCO-3300 or other referral form that has been agreed upon by DHS and the local service provider. When making a referral the following information should be included:
Reason for the referral.
Name of the referring TEA worker.
Recipient's perception of referral (if explored).
Supportive services needed/provided
The above information, if not included on the referral form will need to be attached to the referral form. The referral form may be mailed, faxed, etc. to the provider.
Outcome of Substance Abuse Assessment
Consent Form: In order for DHS to receive information (staffing reports, progress reports, evaluation results test scores, etc.) from the agency on the recipient it will be necessary to complete a consent of release form that meets specific requirements relating to alcohol and drug treatment and that has been signed by the recipient. Therefore, the attached consent form, provided by the Bureau of Alcohol and Drug Abuse Prevention will be used for this purpose.
Treatment not needed: If the service provider recommends that substance abuse treatment is not needed, then the TEA worker will continue with the development of the regular assessment process and employment plan and engage the recipient in the most appropriate TEA work activity for him or her.
Treatment needed: If the service provider recommends that substance abuse treatment js needed, then the worker must determine if services are available for treatment. If services are available, then the worker will have the following options to choose from in dealing with the recipient. The TEA worker should not make this decision alone but in conjunction with the recommendation from the service provider.
Option: 1. TEA recipient engaged in substance abuse treatment will be considered as meeting his or her participation requirement.
Option: 2. Recipient is engaged in treatment in conjunction with appropriate TEA work activity.
Option: 3. Based on the recommendation from the service provider, the recipient will be deferred from participation (refer to TEA policy 2430 # 6 - extraordinary circumstance).
Option: 4. Recipient is deferred because treatment services (waiting list, services not in area, etc.) are not available (TEA policy 2430 # 4 - supportive services not available).
Although the service provider has recommended treatment, the recipient must agree to the treatment before it becomes a part of his or her requirement. Once the recipient agrees upon treatment, the TEA caseworker will complete an employment plan listing treatment as an activity. It should be noted that substance abuse treatment does not count as an allowable work activity for purposes of calculating the State's federal participation rate. However, this should not be a determining factor as to whether a person will engage in treatment alone or in conjunction with an allowable work activity. That decision should be based solely on what will produce the best outcome for the recipient.
Non-compliance - Due to the nature of substance abusers suffering from relapses/setbacks, it is recommended that at each act of non-compliance the TEA worker should contact the substance abuse counselor to seek advice on whether the recipient is having a relapse and if sanction procedures should be implemented. It is also recommended that a recipient be limited to no more than three acts of non-compliance before sanction procedures are initiated. If it is determined that a sanction should be imposed, then the regular non-compliance sanction procedures will be followed.
Payment for Substance Abuse Treatment - If no other funding source is available to pay for substance abuse treatment services (e.g. Medicaid, Welfare-to-Work agencies, Health Dept, local resources, etc.), then TEA funds may be used to pay for non-medical treatment services. Medical services (which cannot be paid by TEA) include detox services in a medical facility. If the caseworker is unsure of whether a service is medical or non-medical, this should be discussed with the service provider, and if needed, contact the TEA Policy Unit for a determination.
Monitoring/Follow-up - The local county office should complete.a monthly follow-up on the recipient's progress. Monitoring may be conducted via phone, progress reports, etc. Each local office should develop monitoring and follow-up procedures.
If you have any questions regarding this directive, please contact your Program Support Specialist.
Attachments:
Inquiries to: Lorie Williams, TEA Unit, 682-8256 Ron Johnson, TEA Unit, 682-8182 Renee Green, TEA Unit, 682-8266
Desk Guide
For
Alcohol/Drug Abuse Warning Signs
INSTRUCTIONS
FOR COMPLETION OF
DCO-89
PURPOSE
The DCO-89 is used by the TEA Case Worker to obtain substance abuse treatment information on TEA recipients.
COMPLETION
The TEA Worker completes the DCO-89 for the client to sign.
ROUTING
The original copy will be forward to the person or organization that has the information that we are requesting. A copy of the DCO-89 will be given to the client and a copy will be retained in the casefile.
RETENTION
The DCO-89 will be retained until the case file is destroyed.
INSTRUCTIONS FOR COMPLETION OF
DCO-1402
PURPOSE
Form DCO-1402 is used to obtain preliminary information regarding the recipient's skills, employability, and background information. In addition, the form will be used to screen for domestic violence and substance abuse in TEA recipients. Depending upon the individual, the worker may determine additional information is needed to fully complete the evaluation.
COMPLETION
The TEA client will complete the DCO-1402. The worker should review the client's answers and if any questions have not been answered, discuss them with the client. The worker may add the client's responses to the appropriate questions. The client must sign and date the form.
ROUTING
The DCO-1402 will be retained in the casefile. A copy of the DCO-1402 will be given to the client.
RETENTION
The DCO-1402 will be retained until the case record is destroyed.
INSTRUCTIONS
FOR COMPLETION OF
DCO-181
PURPOSE
The purpose of the Employment Plan is to identify a participant's employment goal and the activities that will occur in order to meet that goal.
COMPLETION
This section also includes a space for written comments. The case manager may want to use this space to specifically document how hours will be calculated for participation. It also allows the case manager to document any supportive services issues if this is not clearly evident in the "tasks" listing found in Section IV.
The task/responsibilities section should include specific statements outlining whom is going to do what activity as well as how the activity should be done. Abegin/end date for each activity allows the case manager and customerto clearly understand the expectations of the plan and to monitor progress. Copies of the employment plan page can be made if there is not enough space for all intermediate goals/ tasks.
ROUTING
The original DCO-181 will be filed in the case file and a copy will be given to the recipient.
RETENTION
The D CO-181 will be retained until the case file is destroyed.
016.20.98 Ark. Code R. 040