Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.98-040 - TEA Policy Directive 98-17 Substance Abuse Screening and Treatment for TEA recipients and forms DCO-1402 & DCO-181

Current through Register Vol. 49, No. 6, June, 2024
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
1.
Tremors/Perspiring
2.
Evidence of Current/Recent Intoxication
3.
Prescription Drug Seeking
			 Behavior
4.
Frequent
			 Hospitalization
5.
Dilated Pupils
6.
Track Marks
7.
Suicide Talk/Attempts
8.
Depression
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
1. Tremors/Perspiring
2. Evidence of current/recent
			 intoxication
3. Prescription Drug
			 Seeking Behavior
4. Frequent Falls,
			 Unexplained Bruises/Injuries
5.
			 Frequent Hospitalization
6. Dilated
			 Pupils
7. Track Marks
8. Suicide Talk/Attempts Depression
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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.
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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.
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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
Section
			 I: Place a check mark next to the appropriate identifier. Include
			 dates of the plan development and/or update. If you are Updating a plan be sure
			 to indicate how this update was done.
Section
			 II: This section is designed to help the case manager and customer
			 remain focused on long range goal of planning activities (the vision of the
			 program). This goal may simply say "Mrs. Jones will be steadily employed on
			 full time basis." The projected timeframes may be open-ended. NOTE: Not all
			 families will require the same amount of time to reach full time employment
			 and/or self-sufficiency.
Section
			 III: Identify the work activity the client is participating in
			 that relates to the intermediate goal in Section
			 IV. Be sure to include the date
			 of assignment to the activity as well as a projected completion date for this
			 assignment. (Some intermediate goals may not relate to an allowable work
			 activity. If this is the case still complete this section showing the activity
			 the client is engaged in (e.g., substance abuse treatment, etc.)
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.
Section IV: Intermediate goals are the steps
			 necessary to reach the long-range goal of the plan. These goal statements
			 should be specific and tied to begin and end dates. In other words, document
			 when the work on the goal begins and when it is expected that the goal will be
			 obtained (end date).
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.
Section V: Review the signature page with the
			 client prior to signing and dating the plan. Both the client and case manager
			 will sign this page.
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.