“Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation. Social workers:
• Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services;
• assess how social welfare and economic policies impact the delivery of and access to social services;
• apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice” (CSWE, 2015).
My work with the 38-year-old, John Doe, was informed by social welfare policies regarding access to insurance coverage. The Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) provided individuals with employer-based insurance the option of retaining their coverage if their employment was terminated. This policy has helped many individuals and their families seek medical care and protection during some of their most vulnerable periods (i.e., in the wake of job loss). An understanding of this policy kept John Doe’s family protected (covered) and allowed him to seek the substance use treatment he needed.
At a micro level, policy practice informs almost every action and interaction at the substance abuse treatment facility. In addition to organizational policies and procedures, many of the counselors are bound by a code of ethics established by The California Consortium of Addiction Programs and Professionals (CCAPP).
I also had the opportunity to influence policy changes within the agency by helping to write and develop training materials regarding clinical documentation. The following is an excerpt from a document which provides information on relapse potential (per ASAM Criteria) for use in clinical treatment review forms:
Relapse potential is designated as stable, mild, moderate, substantial and severe per the
ASAM (American Society of Addiction Medicine) criteria. Review the client’s history and
progress to determine the appropriate designation. The majority of clients receiving
services at EAS present with a relatively high relapse potential. The following guide will
help improve understanding of severity (CIBHS, n.d.):
Mild:
-Minimal relapse potential with some vulnerability
-Some craving with ability to resist
-One or two changeable demographic risk factors
-Marginally affected by external influences
-Mostly non-impulsive
-Mostly confident
-Low level of risk-taking or thrill-seeking
-Fair self-management and relapse prevention skills
-Needs support and counseling to maintain abstinence, deal with craving, peer pressure,
and lifestyle
and attitude changes
-Mostly adherent with prescribed psychiatric medications
-Episodic use of alcohol (less than weekly)
-Sporadic use of drugs (<1/week), not injected
Moderate:
-Impaired recognition and understanding of substance use relapse issues
-Difficulty maintaining abstinence despite engagement in treatment
-Able to self-manage with prompting
–Some craving with minimal/sporadic ability to resist
-One or two durable demographic risk factors
-Moderately affected by external influences
-Neither-impulsive nor deliberate
–Uncertain about ability to recover or ambivalent
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Barriers to treatment:
-Moderate level of risk-taking or thrill-seeking
-Mostly adherent with prescribed psychiatric medications with failure likely to result in
moderate
to severe problems
-Regular use of alcohol (once or twice a week)
- Moderate use of drugs (1-3X/week), not injected
Substantial:
-Little recognition and understanding of substance use relapse
-Has poor skills to cope with and interrupt addiction problems, or to avoid or limit relapse or
continued
use
-Severe craving with minimal/sporadic ability to resist
-Three demographic risk factors
-Substantially affected by external influences
-Somewhat impulsive
-Dubious about ability to recover
-High level of risk-taking or thrill-seeking
-Mostly non-adherent with prescribed psychiatric medications with failure likely to result in
moderate to
severe problems
-Frequent use of alcohol (3 or more times a week)
-Frequent use of drugs (more than 3X/week) and/or smoking drugs
Severe:
-Repeated treatment episodes had little positive effect on functioning
-No skills to cope with and interrupt addiction problems or prevent/limit relapse or
continued use
-Severe craving with no ability to resist
-Four or more significant demographic risks
-Totally outer-directed
-Very impulsive
-Very pessimistic or inappropriately confident about ability to recover but is not in
imminent danger or
unable to care for self – no immediate action required
-Dangerous level of risk-taking or thrill-seeking
-Not at all adherent with prescribed psychiatric medications with failure likely to result in
severe
problems
-Daily intoxication
-Daily use of illicit drugs and/or IV drug use
-Is in imminent danger or unable to care for self
Ivan Carnice 