The Addiction Counselor's Documentation Sourcebook

Brenda S. Lenz, MS, is an educator and licensed counselor specializing in treating addictions in women and adolescents. She is currently a substance abuse counselor at Marquette University.

CD Contents xi

Introduction xv

Chapter One Precontact: Referral Forms 1.1

Form 1.1: Referral for Services 1.2

Form 1.2: Appointment Notification/Confirmation Letter 1.3

Form 1.3: Referral and Treatment Compliance Follow-Up Letter 1.4

Form 1.4: Thank You for Your Referral 1.5

Form 1.5: HIPAA Notice of Privacy Practices 1.6

HIPAA Privacy Authorization for Use and Disclosure of Personal Health Information 1.8

Form 1.6: HIPAA—Client Sign-In Sheet 1.9

Chapter Two Intake and Assessment Forms 2.1

Form 2.1: Initial Client Information Fact Sheet 2.3

Form 2.2: Confidential Brief Health Information Form 2.4

Form 2.3: Therapist Clinical Assessment 2.5

Form 2.4: Chemical Dependence Assessment Matrix 2.11

Form 2.5: Substance Abuse Assessment Matrix 2.13

Form 2.6: Acuity of Need/Level of Treatment Assessment Matrix 2.15

Form 2.7: Informed Consent and Payment Agreement for Services 2.17

Form 2.8: Authorization for Disclosure of Information 2.18

Form 2.9: Client Rights and Limits of Confidentiality Handout and Acknowledgment 2.19

Chapter Three Treatment Forms 3.1

Form 3.1: Behavioral Contract 3.3

Form 3.2: Contract against Suicide, Self-Harm, or Harm to Others 3.4

Form 3.3: Client Input for Treatment Planning 3.5

Form 3.4: Master Treatment Plan 3.6

Form 3.5: Treatment Plan Update/Revision Form 3.9

Form 3.6: Group Therapy Progress Note 3.10

Form 3.7: Individual/Family Therapy Session Progress Note 3.11

Form 3.8: Telephone Contact Progress Note 3.12

Form 3.9: Therapeutic Materials Loan Record 3.13

Form 3.10: Eye Movement Desensitization and Reprocessing (EMDR) Information Handout 3.14

Form 3.11: Eye Movement Desensitization and Reprocessing (EMDR) Consent for Treatment 3.18

Form 3.12: Eye Movement Desensitization and Reprocessing (EMDR) Progress Note 3.19

Form 3.13: Recovery Program Meeting Review/Critique Form 3.21

Chapter Four Treatment Forms: Program Administration Documentation 4.1

Form 4.1: Client Encounter Summary Log Sheet 4.3

Form 4.2: Monthly Progress Note/Report 4.4

Form 4.3: Recovery Program Attendance Verification Form 4.6

Form 4.4: Request/Referral for Extended Services 4.7

Form 4.5: Request/Referral for Additional Services 4.8

Form 4.6: Request for Drug Screening by External Providers 4.9

Form 4.7: Treatment Program Attendance/Completion Record 4.10

Form 4.8: Certificate of Completion 4.11

Form 4.9: Case Staffing Record 4.12

Form 4.10: Treatment Termination Warning 4.13

Form 4.11: Treatment Termination Notification 4.14

Form 4.12: Treatment Discharge Summary 4.15

Form 4.13: Request for an Accounting of Disclosures 4.16

Form 4.14: Disclosure Tracking Log 4.17

Chapter Five Program Evaluation 5.1

Form 5.1: Outcome Measurement Tracking Form 5.11

Form 5.2: Informed Consent for Participation in Outcome Assessment 5.12

Chapter Six Addictive Behaviors: Materials for Use in Psychoeducational Groups 6.1

Presentation 6.1: Psychopharmacology, Part I 6.3

Presentation 6.2: Psychopharmacology, Part II 6.9

Presentation 6.3: The Process of Addiction 6.16

Presentation 6.4: The Process of Relapse 6.20

Presentation 6.5: Addiction and Contemporary Culture 6.23

Presentation 6.6: Switching Addictions: Other Compulsive Behaviors 6.27

Chapter Seven Recovery Resources and Skills: Materials for Use in Psychoeducational Groups 7.1

Presentation 7.1: The Process of Recovery 7.3

Presentation 7.2: Recovery Programs and Resources 7.8

Presentation 7.3: Lifestyle Changes 7.13

Presentation 7.4: Common Problems and Issues in Recovery 7.16

Presentation 7.5: Relapse Prevention, Part I 7.22

Presentation 7.6: Relapse Prevention, Part II 7.26

Presentation 7.7: Physical and Emotional Self-Care 7.29

Presentation 7.8: Stress Management 7.33

Presentation 7.9: Communication Skills 7.37

Presentation 7.10: Healthy Relationship Skills 7.43

Presentation 7.11: Setting and Achieving Goals 7.48

Presentation 7.12: Problem-Solving Skills 7.51

Presentation 7.13: Coping with Anger and Resentment 7.54

Presentation 7.14: Coping with Depression and Anxiety 7.58

Presentation 7.15: Resisting Pressures to Drink or Use 7.62

Chapter Eight Other Mental Health Issues: Materials for Use in Psychoeducational Groups 8.1

Presentation 8.1: Family Dynamics 8.3

Presentation 8.2: Domestic Violence 8.8

Presentation 8.3: Suicide Awareness and Prevention, Part I 8.13

Presentation 8.4: Suicide Awareness and Prevention, Part II 8.18

Presentation 8.5: Trauma and Posttraumatic Stress Disorder 8.23

Presentation 8.6: Co-Occurring Disorders 8.28

Presentation 8.7: Codependency 8.32

Presentation 8.8: Grief and Loss 8.35

CD-ROM Information C. 1