Advances in Addiction & Recovery (Spring 2017)

SPRING 2017 Vol. 5, No. 1

Protecting Patient Data in the Electronic Age: Updating CFR Part 2

By Kimberly Johnson, PhD, Center for Substance Abuse Treatment, SAMHSA

Clinical Supervision: How Well Do You Know Your Ethical Obligations?

Predatory Patient Recruitment: Waste, Fraud, and Abuse

Addressing Privacy Concerns to Advance Research

CONTENTS SPRING 2017 Vol. 5 No. 1 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners.

NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 95,000 addiction coun­selors, educators, and other addictionfocused health care pro­fessionals in the United States, Canada, and abroad. NAADAC’s members are addic tion counselors, educators, and other addic tionfocused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address 44 Canal Center Plaza, Suite 301

Alexandria, VA 22314 Telephone 800.548.0497 Email naadac@naadac.org Fax 703.741.7698 Managing Editor

Jessica Gleason, JD

Communication Manager

Kristin Hamilton, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

Kirk Bowden, PhD, MAC, NCC, LPC Rio Salado College

Kansas Cafferty, LMFT, MCA, CATC, NCAAC True North Recovery Services National Certification Commission for Addiction Professionals (NCC AP)

Thomas Durham, PhD

NAADAC, the Association for Addiction Professionals

Deann Jepson, MS Advocates for Human Potential, Inc.

■ F EAT UR ES

James McKenna, MEd, LADC I AdCare Hospital

21 Protecting Patient Data in the Electronic Age: Updating 42 CFR Part 2 By Kimberly Johnson,

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

NAADAC, the Association for Addiction Professionals

PhD, Director, Center for Substance Abuse Treatment (CSAT), Substance Abuse & Mental Health Services Administration (SAMHSA)

24 Addressing Privacy Concerns to Advance Research By Jack B. Stein, PhD & Maureen P. Boyle,

Article Submission Guidelines We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Please submit story ideas and/or articles to Jessica Gleason at jgleason@naadac.org.

26 Clinical Supervisors: How Well Do You Know Your Ethical Obligations? By Thomas G. Durham,

For more information on submitting articles for inclusion in Advances in Addiction & Recovery, please visit www.naadac.org/advancesin-addiction-recovery.

PhD, National Institute on Drug Abuse (NIDA) PhD, NAADAC Director of Training

30 Predatory Patient Recruitment: Waste, Fraud, and Abuse By H. Westley Clark, MD, JD, MPH, Dean’s Executive Professor of Public Health, Santa Clara University, Santa Clara, California

34 Counselor Claims and Complaints: By the Numbers By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

■ DEPA R T M EN TS

Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession.

Advertise With Us For more information on advertising, please contact Elsie Smith, Ad Sales Manager at esmith@naadac.org.

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President’s Corner: Ethics & Peer Recovery Support By Gerard J. Schmidt, MA, LPC, MAC

Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5

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From The Executive Director: The Need to Stay Vigilant! By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

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This publication was prepared by NAADAC, the Association for Addiction Pro­fes­sionals.

Reproduction without written permission is prohibited. For more in­formation on obtaining additional copies of this publication, call 1.800.548.0497 or visit www. naadac.org.

Ethics: Enforcing the NAADAC/NCC AP Code of Ethics By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

Printed April 2017

12 Membership: Regional Vice-President Elections for 2017–2019 By Jessica Gleason, JD,

STAY CONNECTED

NAADAC Director of Communications

17 Certification: NCC AP CHair Goodbuy & Hello By Kathryn Benson, LADAC II, NCAC II, QCS, NCC AP Consultant & Jerry Jenkins, MEd, MAC, NCC AP Chair

19 Membership: NAADAC Annual Awards & Nominations Process By HeidiAnne Werner, NAADAC Director of Operations & Finance

38 NAADAC CE Quiz 39 NAADAC Leadership

ALL IMAGES FROM SHUTTERSTOCK UNLESS OTHERWISE NOTED

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■ PR ES ID ENT ’S CO RN E R

Ethics & Peer Recovery Support

By Gerard J. Schmidt, MA, LPC, MAC, NAADAC President

The introduction to NAADAC’s newly updated Code of Ethics states that “Ethics are generally regarded as the standards that govern the conduct of a person.” As treatment professionals, we must keep this principal ever before us as we interact, work with, coach, and treat those individuals whose care has been entrusted to us.

Clients come to us seeking not only guidance and a path to recovery, but also insight into a change in life style and a process for that change.

We as treatment professionals need to be guarded in how we direct and assist these individuals in this change process. We need to be aware of our own biases and be careful so as to not impose these onto our clients.

In addition to this, we need to take those steps to be certain that we are open to the client’s needs, desires, self-determination and willingness to engage in treatment to the extent they can at the onset and throughout their course of care.

Peer recovery support is in many ways somewhat of a return to where the addiction profession began, now with clearer boundaries, knowledge, skills, and abilities attached to the process. It is an essential element in the continuum of care for an individual in their treatment and recovery processes. Peer Recovery Support Specialists are individuals who are in

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recovery from substance use and/or co-occurring mental health disorders and can often times present unique and conflicting aspects to the inter­ actions peer recovery support specialists might have with the people they are supporting. Transference and counter-transference issues abound without the supervision and clinical support necessary to monitor and evaluate the health of the peer recovery support specialist. Due to the complexity and uniqueness of these potential issues, NAADAC, the National Certification Commission for Addiction Professionals (NCC AP), and the Peer Recovery Support Specialist Development Advisory Committee felt it vital to create a separate Code of Ethics specifically for Peer Recovery Support Specialists to help recovery support specialists navigate the unique space of their scope of practice and avoid potential pitfalls.

The NAADAC/NCC AP National Certified Peer Recovery Support Specialist (NCPRSS) Code of Ethics outlines basic values and principles of peer recovery support practice and serves as a guide for responsible and ethical standards for peer recovery support.

First and foremost, peer recovery support specialists have a responsibility to understand the boundaries and scope of their expertise, be aware President, continued on page 7 ☛

■ F R O M T H E E X E C U T I VE DI RE C TOR

The Need to Stay Vigilant!

By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

At the time of this writing — the 7th week that the new Trump Administration has been in office — there are Congressional proposals to change Medicaid into a block grant that would limit funds and access to the addiction and co-occurring treatment systems that have been building over the past six years. Currently, the Affordable Care Act has resulted in over 20 million people gaining access to the health care systems, many of whom have addiction/substance use and co-occurring disorders. Our concern is that before the current ACA is dismantled, a clear, efficient, and well-articulated “replacement” affordable health care insurance plan will not be created that will meet the needs of and include the major initiatives of the ACA. Now is the time to build a relationship, if you have not done so ­already, with your local, state and national legislators and decision makers to educate them on the rising addiction epidemic that your community is facing.

The current opioid crisis, the upcoming marijuana crisis, and the constant alcohol crisis are affecting communities across the country. Your voice, your education and your experience are needed now more than ever! Fund reduction is not going to change the tide of an ever growing addicted America — we need a National Strategy for Prevention, Treatment and Recovery Support, as articulated in the Surgeon General’s Report.

The ACA required initiatives that are important to have in any national health plan, including: • Preventing loss of insurance coverage due to preexisting conditions • Medicaid expansion to include addiction/substance use and mental health disorders • Subsidies for health insurance for low income individuals • Funding for community health centers • Systems for coordinated care, including prevention, treatment and recovery support • Quality care for persons of diverse populations (race/ethnicity/ sexual orientation) In addition to issues revolving around healthcare, here are other important issues to make sure you are staying on top of and advocating to secure your services and your profession: • Quality Improvement of your program is essential to ongoing funding. This includes using evidenced based practices and promising practices such as Medicated Assisted Treatment and Recover (MATR).

Medication plays a role in addiction treatment and long term stability and recovery. Medications that are appropriate for the individual coupled with therapy for the individual and their family. Motivational Interviewing and counseling that engages the client in their role and responsibility for treatment, cognitive behavioral therapy that assists the client in learning new ways and building new brain neuropathways to stronger behavior and patterns of recovery and family therapy that addresses the behavior patterns in the family that are not functional to long-term change. Quality improvement suggests that having a system for outcome data and analysis that informs changes in treatment and recovery programming is not only helpful for the program and therefore, the clients, it is essential to evidence

that your program is providing essential services that are meaningful and long term for the clients you served.

• A National Credentialing system that is standardized across America that is credible, understandable and portable. Confusion is created by the varied addiction credentials throughout our country. MCOs/PPOs/ BHOs find it easier to reimburse credentials that are standardized from state to state, especially as we nationalize insurance and Medicaid. These same national standards and tests can be used at the state level to ensure portability from state to state. For the Addiction Professional, it provides name, a public and across-discipline knowledge level of cred­ible education, training and competencies. The alphabet soup of cre­dentialing levels is tailored to a few that become immediately recognizable. Currently, the National Certification Credential for Addiction Professionals (NCC AP) credential for Master degree level — the MAC — is the most recognized and reimbursed credential in the addic­tion treatment arena. NAADAC is working with states that want to achieve this level of recognition and standardi­ zation. Most of the public have at some level of recognition what an MSW is — we want that same level of recognition for Addiction Professionals at the NCAC I, NCAC II, and MAC levels.

• Professional accountability for your individual professional growth and development in order to remain relevant in the workplace and employable. Higher standards of education, current training and ongoing clinical supervision are the tone for clinical work and practice. Some states have moved to a Master’s or at the very least, a Bachelor’s for clinical work in private and public practice. Peer Recovery Support Specialists are also ­encouraged to continue with their education, training and supports in order to develop their own plan of growth and development. Taking the value of continuous professional development and life-long learning is no longer seen as a practice for only those in the private addiction industry, it is seen as a necessary component of every level of continuum of service providers — from the Intern, to the Recovery Support Specialist, to the Technician and through to the clinician and the clinical supervisor.

Competing in the market place with other disciplines such as Social Workers, Marriage and Family Therapists, Licensed Counselors or Mental Health Professionals require the Addiction Professional, who may also hold one or more of these other discipline credentials, to be continuously improving in their own professional growth and development.

• Securing your Self and your Professional identity means belonging to and being involved, to some degree, to your professional membership organization that recognizes your needs, advocates for your profession and your specific practice, works with the Federal organizations, departments, the Administration and Congress, and partner with allied organizations to bring your voice to the table and create a space for your needs and the clients you serve to be heard. NAADAC has been that organization for 45 years! Yes, 45 years ago NAADAC formed as NCAC and began the journey of creating, developing, documenting and funding a profession of people who cared for those with alcoholism and drug Executive Director, continued on page 7 ☛

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President, continued from page 4

of the limits of their training and capabilities, and collaborate with other professionals and recovery support specialists to best meet the needs of the persons they are serving. They have a responsibility to help persons in recovery achieve their own personal recovery goals by promoting selfdetermination, personal responsibility, and the empowerment inherent in self-directed recovery. Peer recovery support specialists need to be able to recognize when a person they are working with is in need of additional care beyond the scope of their services. Often times peer recovery support specialists become enmeshed in the supportive relationship they have and fail to see outside of their services to the total continuum of care for an individual in early recovery who might be in need of therapeutic, education and/or vocational services. Peer recovery support specialists need to be careful that they do not practice outside of their scope of practice/service and do not give the person they are serving the impression that they are either directly or indirectly providing counseling or other clinical services to that individual.

Peer recovery support specialists also need to remain skilled and knowledgeable in the core competencies related to their specific role in the continuum of care. They have a responsibility to keep a basic level of understanding of the continually evolving issues surrounding substance use, addiction, recovery, and mental health fields, as well as a comprehensive understanding of the referral resources in their community from basic needs (housing, food, clothes), to medical and emergent care, to therapeutic services. They need to have a level of understanding of the diseases, the progression of the diseases, the continuum of care available to support the treatment and recovery of these diseases, and how to help the persons they serve receive the treatments and services necessary for recovery. While peer support is an invaluable and an essential part of early, as well as long term, recovery, peer recovery support specialists need to remain current on treatment issues, open to feedback via treatment team, and responsive to fluctuating changes on the part of the persons they are serving. There are going to be times where an adjustment in an individual’s care plan is necessary and peer support plays a critical role in assisting the individual to the level of care or to the resources necessary for healthy and responsible decisions. To this end, peer recovery support specialists must be current on all available treatment resources, and be in the position to assist the individual to the appropriate resource, or assist as part of the treatment team in accessing that care.

Throughout this all, peer recovery support specialists also have a responsibility to maintain high standards of personal conduct and conduct themselves in a manner that supports their own recovery, to seek their own recovery supports and maintain a system of support that is a safety net for their own long-term recovery.

The complexities discussed above call into focus the need for peer recovery support specialists to maintain regular and structured supervision.

Treatment providers need to be engaged in ongoing clinical support for the services they are providing. Many peer recovery support specialists have never been in a setting where they are part of a continuum of care, whether directly or indirectly involved in a multi-disciplinary team providing a variety of services for a person in recovery. It is important and critical to the care of the individual that recovery support specialists receive support, guidance, and insight in the review of the supportive services they are providing. How this supervision structure is employed will be dependent on how and where individuals are affiliated in their recovery support service provision of care. In some instances, peer recovery support specialists are private providers working in a contractual setting with other providers or not, while others are part of a total continuum of care provided by a

single entity. Either way, peer recovery support specialists need to perceive the value of this supervisory relationship and the vital role it plays in the provision of the services they are engaged in as well as in their own support system to undergird the work they are doing.

The role of peer recovery support specialists is vital in the ever changing and emerging profession of long-term recovery for those with substance use and mental health disorders. In today’s time with the uncertainty of the Affordable Care Act, consistent and quality treatment in a changing and uncertain environment is critical. However, we need to make certain that peer recovery support specialists are upholding themselves to the basic values and principles of peer recovery support practice/services and do not violate boundaries and ethical standards. We need to take special measures to ensure those that are new coming into the delivery of peer recovery support are prepared in advance for the tasks they are being entrusted with and are encouraged and exposed to ongoing training and education on substance use and mental health disorders and all of the related issues.

Those doing the vital work of recovery support need to embrace and review NAADAC’s National Certified Peer Recovery Support Specialist (NCPRSS) Code of Ethics. Each have a responsibility to know and honor the scope of practice/services as well as being aware of potential pitfalls and of colleagues or anyone who appears to be in violation or askew of these.

Our mantra should always be: “do no harm and do not go beyond your area of expertise, training or education.”

To learn more about the National Certified Peer Recovery Support Specialist (NCPRSS) credential and/or Code of Ethics, please visit www. naadac.org/ncprss.

Gerard J. Schmidt, MA, LPC, MAC, is President of NAADAC, the Association for Addiction Professionals and the Chief Operations Officer at Valley HealthCare System in Morgantown, WV. He has served in the mental health and addictions treatment profession for the past 45 years. Publications to Schmidt’s credit include several articles on the development of Employee Assistance Programs in rural areas and wellness in the workplace, addictions practice in the residential settings and an overview of addictions practice in the United States. He has edited Treatment Improvement Protocols for CSAT for several years and has been active with the Mid-Atlantic ATTC. Schmidt had served as Chair of the National Certification Commission for Addiction Professionals (NCC AP) and NAADAC’s Public Policy Committee, and as NAADAC’s Clinical Affairs Consultant. Awards include the Distinguished Service Award in 2003 and the Senator Harold Hughes Advocate of the Year in 2010. In addition to his national and international work, Schmidt has been active within West Virginia in advocating and supporting State legislative issues related to addictions and addiction treatment.

Executive Director, continued from page 5

addiction to the point of working with NIAAA to study the competencies, knowledge components and skills necessary to treat the diseases of addiction. NAADAC continues to educate and leverage your voice in the Federal, State and Public market place! 45 years strong and not waiving from the vision nor the mission to be the premier organization for addiction focused professionals to serve those individuals, families and communities that are needing the education, prevention, treatment, and recovery support to reduce the ravages of these diseases of the brain that are known as addiction/substance use disorders and co-occurring disorders. Stand with us as we move to engage the new Administration and Congress to build a stronger and more secure America!

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics.

Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.

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■ Et h i cs

Enforcing the NAADAC/NCC AP Code of Ethics

By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair The NAADAC/NCC AP Code of Ethics was revised, approved by the General Board, and put into effect on October 9, 2016. A code of ethics establishes parameters specific to professional conduct; the NAADAC/ NCC AP Code of Ethics (hereinafter referred to as the Code) presents the principles and standards that guide the everyday professional conduct of anyone who provides addiction-related and ancillary services.

Enforcing the Code is important to safeguarding the integrity of our profession, while first and foremost protecting the consumers of our services (i.e., clients and patients). It is important that Complainants understand the Code and what it covers. While the Code does not replace federal, state and/or local laws nor replace certification or licensure rules of the state regulatory body, providers have an obligation to be aware of

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the Code’s parameters and recommendations. In the case of a potential ethical violation, the Complainant will need to study the Code and the laws/rules to determine where the strictest mandate lies, as that is where they would initially file their complaint.

Providers and Complainants begin by using an ethical decision making tree to illuminate and expand the problem. For an example of an ethical decision making tree see chart on page 9.

NAADAC and NCC AP have policies and procedures specific to receiving and addressing an ethics complaint. The information in the chart on page 10 outlines NAADAC’s Article XV – Ethics Enforcement Procedure.

NAADAC and NCC AP want the process of receiving, reviewing, and addressing an ethical complaint to be as transparent as possible, while maintaining strict adherence to the need for confidentiality and professionalism.

As professionals, allied service providers, and organizations, we have an obligation to the public first.

We have an obligation to keep clients safe and free from harm during the provision of services in all settings.

If you should decide to file an ethics complaint, please make sure to provide the Ethics Committee with all relevant documentation, explanations, and data. If the case has been filed with a state agency, the Ethics Committees need a copy of the complaint and the corresponding documentation submitted to the state. The Ethics Committees’ are not able to act on complaints that do not fall within the scope of NAADAC’s/NCC AP’s Code of Ethics. The Complainant’s and Respondent’s contact information (name, address, email, phone numbers) is crucial if a complaint is to be investigated. In your letter to the Ethics Committee signaling a formal complaint, please include: the specifics of the case, the players involved (all information sent to the Ethics Committee is deemed confidential, i.e., client names, etc.), an explanation of your concerns, a run-down on what you have tried previously to remedy the situation, and which NAADAC/ NCC AP Code of Ethics Principles have been violated. Missing information keeps the Ethics Committees’ from acting in a timely manner. Every effort is made to make sure all the necessary information has been gathered

prior to rendering a decision. All complaints filed with NAADAC or NCC AP are taken seriously.

To read the newly updated 2016 Code of Ethics, please visit www. naadac.org/code-of-ethics.

Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, an MA in Counseling, and a BA in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Pro­ fes­sional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is a NCC. She is a core faculty member at Walden University, and she maintains a private practice where she works with supervisees who are working on credentialing. Johnson is the Past-President of the Colorado Association of Addiction Professionals (CAAP), and is currently NAADAC Treasurer and Ethics Chair.

She previously served as NAADAC’s Southwest Regional Vice-President. In Colorado, Johnson is involved in regulatory and credentialing activities as well as workforce recruitment and retention initiatives. She speaks and trains regionally and nationally on a variety of topics. Her passions beyond workforce retention include pharmacology of drugs of addiction, infectious diseases, ethics, motivational interviewing, and clinical supervision.

Ethical Decision Making Tree

1 2 3 4 5 6 7 8 9

• IDENTIFY the ethical dilemma and/or legal issues • Gather specific and objective information; clarify and clearly articulate the problem(s)

• APPLY the NAADAC/NCC AP Code of Ethics and applicable laws • Find the applicable Principle(s) in the Code, apply Principle, and apply standard where possible • EXAMINE the nature and dimensions of the dilemma • Examine Principles, seek supervision/consultation; contact NAADAC and other applicable associations, and state regulatory agencies for guidance • GENERATE list of potential options/solutions • Brainstorm all potential options/solutions; consult with supervisor or consultant

• CONSIDER potential consequences of each option/solution generated in Step #4 • Evaluate each option’s pros and cons, ponder implications, and eliminate problematic options • EVALUATE the selected options and develop a course of action • Make sure option(s) are fair, can pass public scruitiny, and are a course of action another counselor might consider for this particular dilemma; if option(s) pass test, move on to implementation • IMPLEMENT the chosen course of action • Carry out the plan; taking necessary steps regarding ethical dilemma may be difficult or easy

• ANALYZE the implementation of the plan • Determine if actions had anticipated effect and consequences; if plan worked, continue on • RE-ASSESS if implementation was not successful. Begin decision-making process again • Complex ethical dilemmas require more time to thoroughly analyze all aspects of the issue • Reach out to NAADAC and/or NCC AP Ethics Committee when unclear about potential options and actions

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NAADAC Ethics Enforcement Procedures EXPECTATIONS AND SCOPE OF MEMBERS AND CREDENTIAL HOLDERS a

Anyone who is a member of NAADAC and/or is credentialed by NCC AP (i.e., NCAC I, NCAC II, MAC, etc.): (a) operates from a unique position of trust and responsibility; (b) provides the highest quality of care; (c) acts in the best interest of those individuals who seek the credential holder’s (hereinafter referred to as credentialee) services; and (d) assists clients with helping themselves.

b

NAADAC and NCC AP use the NAADAC/NCC AP Code of Ethics to guide the member and/or credentialee in maintaining a high level of ethical conduct. The member and/or credentialeer is expected to perform competently and consistently within the framework of the NAADAC/NCC AP Code of Ethics.

c

The Ethics Committees’ procedures provide for the protection of the public interest and the rights of the member and/or credentialee. All NAADAC members and/ or NCC AP credentialees are required to read and promise to adhere to the Code of Ethics as a part of a NAADAC membership application and application for NCC AP certifications. NAADAC members/NCC AP credentialees who fail to meet these ethical standards are subject to disciplinary action and may have their membership or credential revoked.

d

The Code of Ethics is applicable to the conduct of all NAADAC members and NCC AP credentialees.

FILING AND PROCESSING A COMPLAINT

a

The process of filing and processing a complaint is confidential.

b

Persons or entities wishing to file a complaint against a NAADAC member or NCC AP credential holder may do so by completing the appropriate form available with instructions on the NAADAC website at www.naadac.org/how-to-file-complaint.

c

All complaints must be signed by the complainant(s), and include home addresses, email addresses, and a phone number. The form is mailed directly to: NAADAC Ethics Committee and/or NCC AP Ethics Committee at 44 Canal Center Plaza, Suite 301, Alexandria, VA 22314.

d

Anonymous complaints are not acted on.

e

All submissions should be marked “Confidential.” The complainant(s) must acknowledge, in writing, that they understand that the NAADAC member or NCC AP credentialee accused of ethical violations will receive a copy of the complaint and any related evidence.

f

Once a complaint is received, the complaint is reviewed to determine appropriateness for Ethics Committee action, pursuant to NAADAC and NCC AP policies. It may be determined that the Ethics Committees needs to contact the appropriate state certification body to ascertain whether a concurrent investigation is pending on the same issue(s).

INVESTIGATION OF COMPLAINT

a

On receipt of credible evidence of possible professional misconduct by a NAADAC member of NCC AP credential holder, the Ethics Committee may initiate an investigation.

b

The Chair or designee corresponds with the state, territory or international regulatory/licensing authority to request the report of findings and action taken on the complaint pending before it. If the state, territory or international licensing authority fails or refuses to provide the report requested of the entering of its decision, the Ethics Committees conduct their own investigation.

c

If the requested state, territory or international licensing authority report concludes that a violation or violations occurred, the Ethics Committees close their investigation, and proceed with procedures to revoke the NAADAC membership and/or NCC AP national credential. In the absence of such findings, the Ethics Committees continue their investigation.

a

If the complaint does not merit investigation by the Ethics Committees, the complainant and the respondent will be notified in writing.

• EXAMPLE: The complaint describes a violation of an office policy and/or procedure that is administrative in nature and not clinical in nature.

• The Ethics Committees do not investigate individuals who are not NAADAC members or NCC AP credential holders/applicants.

b

The complaint warrants investigation by the Ethics Committees but there is a state, territory or international level investigation in progress. In such case, the Ethics Committees’ will delay further action pending the outcome of the state proceedings.

c

The complaint merits investigation by the Ethics Committees’, and that there is no comparable state, territory or international level action being taken or confirmed.

INITIAL ACTIONS BY ETHICS COMMITTEES’ CHAIRS ON AN ACTIVE COMPLAINT – BASED ON INITIAL REVIEW

INVESTIGATION AND REPORT a

If the Chairs of the NAADAC and NCC AP Ethics Committees review the complaint and issue a determination that the complaint merits an investigation, a copy of the complaint and any supporting evidence will be forwarded to the respondent by certified mail, indicating that: • An investigation is to take place; • The respondent has thirty (30) days to respond, in writing, prior to a meeting of the Ethics Committee; and • The respondent may indicate in writing that a state, territory or international level investigation into the same matter is in progress, resulting in suspension of Committee action on the complaint, pending the final outcome on the state complaint, once the existence of the state action is confirmed by the Committee.

b

In the absence of a basis to suspend action on a complaint deemed meritorious for investigation, the Chair initiates an Ethics Committee investigation of the specific allegations contained in the complaint, against the provisions of the Standards and all relevant evidence available from the complainant(s) and respondent.

c

Following such investigation as the Ethics Committee deems sufficient, a report shall be submitted to the NCC AP and NAADAC recommending either that the complaint be dismissed or that specific disciplinary action be imposed. The grounds for any recommendation shall be stated in the report.

d

Based upon the action of NCC AP and NAADAC, the Ethics Committee shall issue the decision approved by NCC AP and NAADAC, with a copy mailed, by certified mail, to the respondent and the complainant, including notice to the respondent of any appellate rights.

e

In the absence of the filing of a request for appeal, the decision of the Ethics Committee, as approved and/or revised by the NCC AP or NAADAC, shall be final and disciplinary action imposed shall take effect upon passage of the time period prescribed in the decision.

f

After a decision has been rendered, if a request for hearing is timely submitted, a three-member Hearing Committee is appointed by the NCC AP and/or NAADAC Ethics Committee Chair.

a

A violation of the Standards may result in one or more of the following disciplinary actions: 1. Written Caution: A confidential letter issued to a respondent by the Commission that cautions against specific conduct or behaviors.

2. Reprimand: A formal reproof or warning.

3. Suspension: A time-limited loss of membership or certification for a period determined at the discretion of NAADAC and/or NCC AP. 4. Revocation of Credential: Permanent loss of membership or credential, absent further NAADAC or NCC AP action.

5. Denial: Denial of application for membership or credential.

6. Denial Plus Assignment: Additional education, training and/or supervised experience requirements in conjunction with any disciplinary actions.

POTENTIAL DISCIPLINARY ACTIONS

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■ M EM B ER S H I P

Regional Vice-President Elections for 2017–2019

By Jessica Gleason, NAADAC Director of Communications

Help choose the future leaders of NAADAC! Every two years, NAADAC members have the opportunity to select a Regional Vice-President who will represent their state affiliate on the NAADAC Executive Committee, with four of NAADAC’s eight regional positions being up for election each year.

All 2017–2019 terms will begin on September 27, immediately after the 2017 NAADAC Annual Conference in Denver, CO. This Spring, NAADAC received three nominations for the Southeast Regional Vice-President position and two nominees for the Southwest Regional VicePresident position. Please find each candidate’s statements below in order to inform your vote.

NAADAC only received one nomination from the North Central and Mid-Central regions. Therefore, these two nominees will be seated as Regional Vice-Presidents for the 2017–2019 term without an election. The winning candidates’ statements are listed below for your review. Congratulations to our two winners!

Voting starts on April 30, 2017 and ends May 30, 2017. All NAADAC members from the Southeast and Southwest regions are eligible and encouraged to vote. Eligible members will receive email instructions for voting. Voting can be done online by logging into your naadac.org account or by mail.

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Southeast Regional Vice-President Candidates

Representing Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, & Tennessee

Southeast RVP Candidate:

Angela Maxwell, CSAPC Browns Summit, NC

Southeast RVP Candidate:

James A. Holder, III, MA, MAC, LPC, LPC-S Effingham, SC

Southeast RVP Candidate:

Tom Watkins, CAC II, NCAC, SAP Georgia

Summary of NAADAC activities: Angela has served as the North Carolina Affiliate State President (2010–2014) and currently serves as its immediate past president. She currently serves at the Southeast Regional Vice - President (2015– present) for NAADAC wich includes serving on the NAADAC Board of DIrectors (2010– present), NAADAC Executive Committee (2015–present) and NAADAC Membership Committee (2015–presesnt). Angela also served on the Student Assistant Professional Workgroup for the National Student Assistance Committtee (2010–2011).

Philosophy statement on the future of NAADAC: I believe that the future of NAADAC is bright! As a community mobilizer, I recognize the power in maximizing collaborative efforts. Over the past seven years, I have witnessed NAADAC’s collaborative efforts with SAMHSA, CADCA, INCASE and other national organizations. These efforts have kept the substance use profession on the radar and at the table during critical legislative times.

Collaboration with higher education institutions continues to expand education/training opportunities for emerging professionals. In addition to collaborative efforts, NAADAC had worked to remain financially stable and has judiciously used its resources. To continue its positive trajectory, NAADAC remain connected and relevant to the mission of state affiliates; assess the needs of its affiliates and work collaboratively with affiliates to meet those needs and examine how it represents and engages the full continuum of substance use disorder professionals it serves (from primary prevention to medication assisted treatments to aftercare services, etc).

Summary of NAADAC activities: Jim is the past chair of the NCC AP, having served in that position for two terms, ending his tenure in 2012. In that capacity, he was a non-voting member of the NAADAC Board of Directors.

Prior to that he served 6 years as a Commissioner on the Certification Board. From 2011 to 2014, Jim sat on the IC&RC Advisory Council representing the NCC AP. He chaired the international Committee of NAADAC. He represented NAADAC on the update committee for TAP 21 “The Addiction Counselors Competencies.” In 1999, he won the NAADAC Counselor of the Year Award. In 1999 * 2000, he sat on the SC Board of Examiners for Licensed Professional Counselors representing SCAADAC. He served as the Vice-President of SCAADAC and was the Legislative Chair participating in the NAADAC Legislative conferences in Washington, DC. Philosophy statement on the future of NAADAC: I believe it is essential for addictions professionals to have a voice in Washington and in their state legislatures. It is imperative to build on the progress we have made with certification, parity and licensure. Being professionals in the addiction field it is necessary that we continue our training and research to insure quality care for those with substance use disorders. NAADAC is a major provider of quality training and is a needed source of information, to include cutting edge prevention, intervention, and treatment practices. NAADAC is our liaison for our national policy and congressional decision making. I strongly feel that as Addictions Professionals it is our responsibility to find ways to educate and merge with Physicians, Nurse

Summary of NAADAC activities: Tom Watkins currently serves as the Department of Behavioral Health & Developmental Disabilities, DUI Intervention Program state Regulatory Officer. He has worked in the addiction field over 25 years providing detox, inpatient and outpatient senvices. He was instrumental at helping form one of the earliest Accountability Courts in Northeast Georgia Serving as CEO of an outpatient clinic he designed treatment programs to meet the needs of mixed population adults with addictive needs at affordable pricing.

In his role for the state he provides direction for best practice treatment guidelines to over 650 treatment providers. Finally, he gives back to the industry by serving on non-profit boards. His contributions to client and providers have been recognized by various awards over the years.

Philosophy statement on the future of NAADAC: I believe that the future of NAADAC can benefit from Tom Watkins inclusion as a nominee given his past experience, knowledge in the field and current capacity as a Regulatory officer. He can provide insight to trends in the industry and identify needs of large and small agencies alike. He speaks with a voice of compassion balanced with sound judgment proven by past leadership roles. I feel his commitment to addiction and promoting the standards of our industry are evidenced by service and professionalism.

Other qualifications for Southeast RVP: Education is a baseline of qualifications which include bachelors and masters level but not limited to certifications he has held. Serving the DOT industry he is an active SAP (Substance Abuse Professional). Serving the Criminal Justice

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Southwest Regional Vice-President Candidates

Representing Arizona, California, Colorado, Hawaii, New Mexico, Nevada, & Utah Southwest RVP Candidate:

Julio C. Landero, PhD, MAC, MSW, LCADC, LISAC, NCGC Henderson, NV

Summary of NAADAC activities: President of Nevada Association: SNAAP for two different terms. During that time he conducted state conferences, with scholarships for students for up to two years, and was involved with NAADAC Southwest Regional Conference. Active as a trainer, therapist and administrator of his own private practice. He has been in the addiction profession since 1990 and involved with NAADAC for over 25 years as a member, on the state board and state president for the Nevada chapter of NAADAC two times. He helped lobbied for the Nevada licensure. Five years later continue working with lobbyist to pass the License Clinical Alcohol Drugs Counseling in NV. I am a Clinical Supervisor in NV and I am committed to the addiction profession for life.

Philosophy statement on the future of NAADAC: My philosophy on the future of NAADAC we need to continue trying to get licensure in all the states to get parity in payment like others counseling professions.

Creating new programs to be able to attract more students in the addiction profession.

Other qualifications for Southwest RVP: 1. Private practice for 22 years starting as a counselor intern at ABC Therapy moving up to become a CEO of the company directing seven offices in NV and AZ. 2. Trained and educated in Hispanic/Latino addiction issues within the community.

3. Completed PhD in Clinical Psychology specializing in Juvenal addiction for minorities.

4. Became certify in Domestic Violence counseling and Gambling Problems in Nevada.

5. Heavily involved in self-help groups in the community for 26 years.

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Southwest RVP Candidate:

Jerome L. Synold, MAC Carlsbad, CA

Summary of NAADAC activities: I have been a member for over 20 years.

Participated on a number of local NAADAC activities. Member of the NAADAC executive board for 2 years. Member of AAPAC in California.

Philosophy statement on the future of NAADAC: I believe the future for NAADAC is similar to what it currently does addressing treatment, certification and training issues on the national level. My hope would be that it will address a way to expand their certifications to states like California by cooperation with CCAPP. I still support the idea of a NAADAC state affiate having voluntary national membership. I believe I have the experience and the passion for this field that couid contribute to current and future NAADAC initiatives Other qualifications for Southwest RVP: Director of Treatment Navy Drug and Alcohol for over 10 years. Director of the Navy’s Drug and Alcohol Counselor Training Program for 15 years. CAADAC certification chair. Executive board member of CCAPP helped me become very familar with both the state and national needs of counselors and clients.

Maintain current with counselor needs as Coordinator and Instructor of the University of California, San Diego counselor training.

North Central Regional Vice-President Candidate & Uncontested Winner Representing Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, & South Dakota.

James”JJ” Johnson, Jr., BS, ICS, LADC, NCC II Minneapolis, MN Summary of NAADAC activities: JJ has been a member of NAADAC over 20 years. His involvement started in Wisconsin with WAADAC and he has been a part of this organization ever since. He moved to Minnesota in 2001 and revived the then struggling, almost defunct affiliate slowly but steadily. For the next 10 years he worked sometimes alone growing membership and building the BOD. He served as president of the affiliate for 10 years until in the last 2 years has been able to step back and let a functioning board continue the work. Minnesota Addiction Professionals (MNAP) is Thriving. He is a tireless advocacte of NAADAC. Philosophy statement on the future of NAADAC: I have believed in the mission of NAADAC from my first introduction in Wisconsin by leaders that are still active in NAADAC today. I felt the dedication of the BOD every time I would attend the annual conference. During the first public policy conference I attended in Washington, DC I knew where I wanted

to devote my energy. NAADAC spoke for the Addiction Professionals.

Addiction Professionals face a litany of issues from a shrinking workforce to navigating reimbursement. It’s critical that we have a national voice that can mentor the country during these political and financial difficulties and NAADAC is the obvious choice. I think NAADAC will be the organization that continues to lead us in all things Addiction and Recovery related.

I think the best chance for our profession to unite is through NAADAC. Other qualifications for North Central RVP: JJ has been in the profession of addiction treatment and recovery since 1990. An Addiction Counselor starting in 1991 in LaCrosse, WI. During the ten years he served as a primary counselor in a residential facility and was a trainer and consultant to a project which was responsible for starting outpatient alcohol treatment programs in six rural cities in Northwestern Russia. The program still operating today. In 2001 he was recruited to New Ulm, MN to manage substance abuse programs. During that time he expanded MICD services and developed a homogeneous model of treatment for three country Drug Courts. In 2015 he began his current position as Program Manager for HealthEast. JJ has always been an ally and volunteer for the recovery community.

Mid-Central Regional Vice-President Candidate & Uncontested Winner Representing Illinois, Indiana, Kentucy, Ohio, & Wisconsin.

Gisela Berger, PhD, MAC, LPC, NCC Mequon, WI Summary of NAADAC activities: Having been an active member for many years and in several states, I was recently honored to have been chosen as Vice-President and then President of RAP-WI (Recovery and Addiction Professionals of Wisconsin).

During this time, I revived (and renamed) a dying organization. Today, though small, it is a vibrant part of the addictions treatment community in Wisconsin.

Currently, it is the only organization representing treatment providers.

RAP-WI advocates for our interests in the state legislature, holds twiceyearly conferences, is active in providing networking opportunities for professionals in the field, and allows members the opportunity to gain leadership experience. This revived, energetic association is the result of many years of hard work, including empowering motivated people toward making RAP-WI the premier organization for addiction treatment providers in the state.

On another note, I have been privileged to be a presenter at several local and state-wide conferences as well as several webinars for NAADAC. These presentations are an honor as I enjoy connecting with many, varied addiction treatment professionals.

Philosophy statement on the future of NAADAC: I believe that NAADAC has positioned itself as the premier provider of educational

resources, specialty credentialing, and advocacy efforts from the local to the national level. NAADAC stands alone in providing these many benefits in a cost effective way to everyone working as an addiction professional.

I believe that the current challenge is in crafting an identity that serves to both inform the public and potential clients of our many, varied services as well as indicate to governing and legislating bodies our professionalism.

Our field has come a long way in promoting best practices, integrating medical advances, and promoting psychological well-being in every sense of the word. The coming years will challenge us through the current opiate epidemic through the coming challenge to our authority under the guise of co-occurring disorders. Legislative funds are no longer guaranteed and insurance funds are also a thing of the past. Therefore, it behooves us to look for alternate funding streams and to share this knowledge across the many states and municipalities represented under NAADAC’s umbrella.

These are the many challenges we face, and if we face them together we will all be stronger and our clients healthier!

Other qualifications for Mid-Central RVP: I have served clients in many stages of recovery, have supervised clinicians in many stages of development, and have taught both undergraduate and graduate level students across many disciplines. I still believe that addiction professionals are experts and better trained than any other profession to work with substance use disorders. Our competency and our knowledge far surpasses that of any other profession. It is through this diverse experience that I come to you asking for the opportunity to both build my region’s identity and to represent us to the national governing body.

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Now accepting submissions for the

NAADAC William L. White Student Scholarship The William L. White Scholarship was created to promote student addiction studies research and develop the importance of student research projects in NASAC accredited programs, NAADAC approved programs in higher education, or an accredited addiction studies higher education ­program acknowledged by the Higher Learning Commission (HLC) that provides research or education to the addiction profession.

SCHOLARSHIP BENEFITS • One undergraduate student will receive $1,000; One graduate student will receive $2,000 • Scholarship monies will be submitted in the students’ names to their educational debtor • Recipients will be recognition at the NAADAC Annual Conference.

APPLICATION SUBMISSION The completed application form, academic transcript, letters of reference, and the research paper must be submitted together electronically to NAADAC at naadac@naadac.org, Attention: William L. White Student Scholarship.

Submission Deadline: May 31, 2017 For complete information, including the 2017 research paper theme, eligibility and application requirements, please visit: www.naadac.org/white-scholarship.

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Other qualifications for Southeast RVP: Angela Maxwell is the Prevention and Early Intervention Services Director for Alcohol and Drug Services. She oversees services in ten counties and has worked in substance use prevention 20 years. Angela has a BA Degree in English (UNC–Chapel Hill), MS Degree in Agency Counseling (NC A&T State University) and is currently pursuing a PhD in Leadership Studies (NC A&T State University). After completing her MS, she worked with the local mental center serving youth with severe emotional and behavioral disorders. Angela is a Certified Substance Abuse Prevention Consultant (CSAPC) and has served as an adjunct professor for Guilford Technical Community College. Angela serves on several boards across North Carolina to including the NC Substance Abuse Prevention Providers’ Associafion (Board Chair). Angela has received two statewide substance abuse professional of the year awards (2008, 2010).

Practitioners and other health care providers as part of a treatment team and as consultants.

There is no better time to accomplish this when we take into account the opiate epidemic nationally. The focus is on Physicians to make changes in their clinical care and we need to be there to assist.

Other qualifications for Southeast RVP: Jim has 40 years of experience in the provision of quality counseling care in outpatient, inpatient, and IOP services, both as a counselor and as a program director. He was awarded the title of Honorary Lt. Colonel Aid-deCamp with the Alabama State Militia in 1986 for training provided for professionals in the state. In 2016 he was awarded the Arliss Epps Social Interest Award from the SC Society of Adlerian Psychology. He is actively involved in Sobriety Enhancement research with Francis Marion University, Florence, SC. He continues to provide training at an International level on substance use disorder treatment.

arena he worked in law enforcement and held a CCJS (Certified Criminal Justice Specialist).

Given his acquired education and experience he held a MAC (Master Addiction Counselor).

Seeking to become a counselor with varied cross training he became certified as a Family Violence counselor and certified as a FVIP (Family Violence Intervention Provider).

Finally, he and his wife have served in Mexico working with underprivileged children suffering from families with addictive disorders teaching English as a second language.

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■ CER T IF IC AT I O N

NCC AP Chair Goodbye & Hello

By Kathryn Benson, LADAC II, NCAC II, QCS, NCC AP Consultant & Jerry Jenkins, MEd, MAC, NCC AP Chair

KATHY: To say that the journey as NCC AP Commissioner and then two terms as NCC AP Chairperson has been exciting, growth-producing, and totally rewarding would be an understatement. It has provided me opportunities to learn, grow both professionally and personally, and to stretch my comfort zone to dimensions that I never previously considered. I have grown in my travels around this amazing planet of ours while meeting and working with wonderfully talented and dedicated professionals from a multitude of cultural experiences. Experience has shown that this representation of NCC AP, its mission and standards of professional development, has had both favorable and significant impact on the SUD treatment community and their ultimate benefit to patient care.

I am honored to have been elected to lead this amazing group of dedicated professionals as they have donated their time and energy to insure the NCC AP credentialing process is and will continue to be ethical, professional, fully reflective of established professional competencies, fair, and inclusive for all who seek national and international credentialing.

It is imperative in this moment to shine the spotlight on all the many people I have been privileged to work with, and greatly supported by during my tenure as NCC AP Chairperson. These amazing professionals include, but are by no means limited to: NCC AP Commissioners Thad Labhart, Steve Durkee, Rose Maire, Loretta Tillery, Art Romero, Kansas Cafferty, Tay Bian How, Sandra Street and Retired Certification Director Shirley Beckett Mikell. As NCC AP Chair, I worked closely with the NAADAC Executive Committee as we supported each other’s mission of leadership within the SUD profession. I want to thank all the current and former EC members for their support, guidance, and encouragement with a special appreciation for former NAADAC Presidents Bob Richards and Kirk Bowden, and current NAADAC President Gerry Schmidt for their ability

JERRY: Greeting to all from Alaska!

I am very honored to again be part of the National Certification Commission for Addiction Professionals (NCC AP). My sincere thanks to my predecessor and former Tennessee colleague Kathryn Benson and NAADAC Executive Director Cynthia Moreno Tuohy for helping my transition back onto the Commission.

My previous tenure, from 1993 to 1999, was very rewarding as the Commission matured the National Certified Addiction Counselor (NCAC) Levels I and II credentials and implemented the Master Addiction Counselor (MAC) credential. These credentials provided an instant recognition for addiction professionals who pursued a NCAC I, NCAC II, or MAC to demonstrate knowledge of their profession by meeting a national standard. The standard was developed by incorporating the best practices and critical knowledge areas into a process requiring documented training, experience and demonstrated knowledge. The latter was determined by taking and passing examinations prepared, reviewed and validated by knowledgeable addiction professionals in the field. In other words, we addiction treatment professionals had competency based credentials!

As I rejoin the Commission, I am excited about its work developing specialized credentials and endorsements that provide professionals with formal recognition of their specialized competencies and skills. The current specialized credentials are: Nicotine Dependence Specialist (NDS); National Certified Adolescent Addiction Counselor (NCAAC); National Endorsed Student Assistance Professional (NESAP); National Clinical Supervision Endorsement (NCSE); National Endorsed Co-Occurring Disorders Professional (NECODP); and National Peer Recovery Support Specialist (NCPRSS). As the leader of a company that does recoveryoriented span of life behavioral health services, I fully grasp why these

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to hear me and their on-going generosity of support and wisdom. Finally, the never-ending work and support by all the NAADAC staff requires a huge special THANK YOU! to Donna Croy, Certification Manager, Yao Kouassi, Certification Coordinator, Greg Potestio, Programs and Technology Manager, HeidiAnne Werner, Director of Operations and Finance, Jessica Gleason, Director of Communications, and of course our ever-supportive mentor and leader Cynthia Moreno Tuohy, Executive Director. Thank you each and everyone. You may never realize the powerful impact you have had on me and my ever-evolving spirit.

During our recent years NCC AP has: • created a new credential for Peer Recovery Support Specialists; • created a new credential for Clinical Supervisors; • contracted with and transitioned to Kryterion, our new testing company which now allows for testing on demand and at the national conference, and provides immediate test results for most test takers (with agreement by their credentialing state authority); • engaged in expansion of the use of our testing products by the states of North Dakota, Virginia, Wyoming and Maryland; • successfully completed a comprehensive grandfathering process of credentialing for the NCAC I, NCAC II, MAC credentials, during which approximately 5,500 professionals were issued their national credentials as addiction professionals; • engaged in on-going collaborative work with Association for the Treatment of Tobacco Use and Dependence (ATTUD) and Council for Tobacco Treatment Training Programs (CTTTP) to more fully serve those professionals addressing nicotine use disorders; • engaged in the development of the new NAADAC/NCC AP Code of Ethics, expanding the code to clearly encompass the breath of the ethical guidelines that affect our profession today; • engaged in on-going collaborative work with National Center for Responsible Gaming (NCRG) to more fully serve those profes­ sionals addressing gambling/gaming disorders; • engaged in on-going collaborative work with the National Asso­ ciation for Drug/Recovery Court Professionals to assist in the iden­ ti­fication of needed SUD training, development of Recovery/Drug Court code of ethics and professional standards and subsequent professional credentialing; • and last, but not least, fully engaged with representatives from many countries and U.S. Territories including, but not limited to: Hong Kong, Iceland, Kenya, Micronesia, Pacific Jurisdiction, Puerto Rico, South Africa, South Korea, Thailand, United Arab Emirites, and the International Centre For Certification And Education Of Addiction Professionals (ICCE) in our effort to assist in the continuing development of professional training, credentialing expansion and inclusion of best practices in the delivery of substance use disorder continuum of care in prevention, intervention and treatment services.

The role of professional credentialing in the substance use disorder treatment profession today is essential to the continued role and impact of evidence-based care. Recognizing, implementing, and maintaining professional competencies and current codes of ethical principles and standards of conduct provide an overriding assurance to individuals seeking service that their care will be provided by specially trained professionals. A guarantee that ongoing efforts are in place to insure professionals practice with consistency and standardization of care is paramount to the overall welfare and safety of the public. That is NCC AP’s commitment to the individual/ families seeking assistance. The professional seeking training, support, 18

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and continued knowledge and skill development, the SUD profession as it changes and modifies itself to embrace new research-based treatment modalities, and the general public seeking guidance and care will always be forefront in our commitment to service as the leader in our profession.

It is now with gratitude and excitement that I transition out of my role as NCC AP Chair and into my new role as NCC AP/NAADAC Consultant and welcome into the role of NCC AP Chair Jerry Jenkins, MEd, MAC, a long-time NAADAC/NCC AP involved and highly respected colleague from the great state of Alaska.

Welcome Jerry!

Kathryn Benson, NCAC II, LADC, QSAP, QSC, served as Chair of the National Cer­ti­f ication Commission for Addiction Pro­fessionals (NCC AP), and has worked in the counseling profession since 1972, specializing in addiction issues since 1978. She may be contacted at lightbeing@aol. com with your thoughts or questions.

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credentials are valuable.

Who is the best professional to refer someone to that smokes a couple packs a day? Who is best to work in the school based behavioral health program addressing substance use and emotional disturbance? Who has skills to deal with an adult with both a serious mental illness and serious substance use disorder? Who should be supervising addiction counselors?

What about the person in long term recovery from a substance use disorder who now wants to use her/his lived experience to help others and wants to demonstrate a professional competency? One way to find such professionals is to look for credentials signifying that specific specialization.

Why is this important? Providers need to be helping people recover and become as healthy as possible. This will in turn increase the value of the services provided. Now, as health care is being transformed by analytics and new payment schemes like value based care, it is more important than ever to identify professionals with specialized behavioral health skill sets.

Former NAADAC President Kirk Bowden said it best when he wrote “addiction counseling is a specific profession within the field of behavioral health. To be effective addiction counselors requires a specific, specialized, knowledge base.”1 NCC AP’s credentials are the most effective way to demonstrate having that “specific, specialized, knowledge base.”

I look forward to helping advance the profession and professionals through the NCC AP.

REFERENCE 1 Bowden, Kirk (2015). My Big Concern for the Addiction Counseling Profession. Advances in Addiction & Recovery, Vol. 3, No. 1, p 4.

Jerry A. Jenkins, MEd, MAC, has been the Chief Executive Officer of Anchorage since 2003 adding Fairbanks Community Mental Health Services in 2013. He is in his third year as the President of the Alaska Behavioral Health Association. Anchorage/Fairbanks Community Mental Health Services provides behavioral health services across the span of life from ages 2 to 100. As an addiction treatment professional, Jenkins has over 34 years of experience in treating substance use disorders and mental illness. He has worked in and managed community based, outpatient, halfway and residential treatment services. He is an advocate for safe, affordable and accommodating housing for consumers as well as recovery as the expectation for behavioral health care with particular emphasis on being trauma informed.

■ M EM B ER S H I P

NAADAC Annual Awards & Nominations Process

By HeidiAnne Werner, NAADAC Director of Operations & Finance

Each year NAADAC and its members celebrate and honor people and organizations that have achieved excellence in the treatment, recovery, prevention, medical and educational sectors of our addiction profession over the past year.

Awards are given in seven categories and will be presented during NAADAC’s Annual Conference in Denver, Colorado at the President’s Awards Luncheon. It is important to recognize and honor the distinguished services, accomplishments, and contributions of individuals and organizations to continue to elevate and motivate the profession. Make sure to get your nominations in by May 31st!

Award Categories ■ The ADDICTION EDUCATOR OF THE YEAR AWARD recognizes an adjunct or full-time college/university professor who has contributed through academia to the addiction profession through mentoring students/student chapters, colleagues or addiction professionals and/or by providing ongoing research or other contributions that grow, enhance, advocate and educate for the addiction profession.

■ The LIFETIME HONORARY MEMBERSHIP AWARD recognizes an individual or entity who/that has worked in the addiction profession for at least 25 years, has established through research, publications, presentations or by other means the significance of the addiction profession and its professionals, had demonstrated leadership, service, and contributions to addiction profession, and has supported NAADAC’s mission, vision and Code of Ethics.

■ The LORA ROE MEMORIAL ADDICTION COUNSELOR OF THE YEAR recognizes a counselor who has made an outstanding contribution to the profession of addiction counseling. To be eligible for this award, nominees must: be currently employed as an addiction counseling professional, and actively working as a counselor for not less than three years prior to receiving the award; be an active NAADAC member in good standing (the individual must be a voting member as opposed to an honorary or nonvoting member); have worked with clients (patients) for a sustained period with individual or group contact that fosters recovery from addiction disorders; preferably, be certified, registered or licensed as an addiction professional, although these qualifications are not mandatory; and have demonstrated to the satisfaction of one’s peers full compliance and support of NAADAC’s Code of Ethics.

■ The MEDICAL PROFESSIONAL OF THE YEAR recognizes medical professional who has made an outstanding contribution to the addiction profession. To be eligible for this award, nominees must: be currently employed in the addiction profession and actively working as such for a minimum of three years prior to receiving this award; hold licensure as a Medical Doctor, Registered Nurse, Licensed Practical/Vocational Nurse in their respective state; be an active NAADAC member in good standing (i.e., the individual must be a voting member as opposed to an honorary member or nonvoting member); be working with clients/patients for a sustained period with individual or group contact that fosters recovery from addiction disorders; and have demonstrated to the satisfaction of one’s peers full compliance and support of NAADAC’s Code of Ethics.

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■ The MEL SCHULSTAD PROFESSIONAL OF THE YEAR AWARD r­ ecognizes an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession.

■ The ORGANIZATIONAL ACHIEVEMENT AWARD recognizes an organization that has demonstrated a strong commitment to the addiction profession and particularly strong support for the individual addiction professional. To be eligible for this award, nominees must have been in existence for at least five years and cannot be affiliated with any other organization or company that sells, distributes or supports the consumption of alcoholic spirits or illicit substances.

■ The WILLIAM F. “BILL” CALLAHAN AWARD recognizes sustained and meritorious service at the national level to the profession of addiction counseling. To be eligible for this award, nominees must have a minimum of fifteen years in the addiction counseling profession or related administration, and possess a strong dedication to the addiction profession as demonstrated by involvement in and commitment to a variety of key organizations.

Nominating Information Any NAADAC member in good standing may nominate any eligible individual NAADAC member for any of the above individual awards.

Current members of the NAADAC Executive Committee are ineligible for all awards.

To nominate an eligible addiction professional for a NAADAC award, please submit: (1) a letter of recommendation stating how the nominee fulfills the award criteria; (2) at least three letters of support from three different sources (individuals, organizations, or agencies); (3) the nominee’s resume; and (4) a completed NAADAC Recognition and Awards Nomination Acknoweldgement Form.

To nominate an eligible organization for the NAADAC Organizational Achievement Award, please submit (1) a letter of recommendation including a detailed description of the nominated organization and how the organization has supported the addiction profession; (2) at least three letters of support from three different sources (individuals, organizations, or agencies); and (3) a completed NAADAC Recognition and Awards Nomination Acknowledgement Form.

The NAADAC Recognition and Awards Nomination Acknolwedgment Form requires the nominee to sign a statement acknowledging that he/she meets all of the eligibility criteria for the particular award and has “demonstrated to the satisfaction of one’s peers full compliance and support of NAADAC’s Code of Ethics throughout [his/her] professional career.”

For access to the NAADAC Recognition and Awards Nomination Acknowledgement Form and the specific eligibility criteria for each award, please visit: www.naadac.org/recognition-and-awards.

All award nomination packets must be received by May 31, 2017 for consideration by the NAADAC Awards Committee.

To nominate an individual or organization, please send the required documentation to: NAADAC, the Association for Addiction Professionals Attn: Awards Committee Chair 44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 20

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Materials may also be faxed to the NAADAC Awards Committee (Attn: Director of Operations) at 800.377.1136 or sent by e-mail to naadac2@ naadac.org (please put “NAADAC Awards” in the subject line).

NAADAC does not pay for travel to the venue of acceptance. If the award winner cannot attend the presentation, the award will be sent to the recipient.

Questions?

For more information, please visit www.naadac.org/awards. For further questions, please email NAADAC at naadac2@naadac.org or call 800.548.0497.

HeidiAnne Werner is the Director of Operations & Finance for NAADAC, the Association for Addiction Professionals. Werner has had an extensive career in association management. After starting out as a meeting planner with The American Association of School Administrators, she worked on tradeshows for VNU Expositions, and was the Registration Manager for The Consumer Electronics Association (CEA), where she was responsible for managing all registration for the largest annual tradeshow in the United States. After spending three years at CEA, Werner moved to the vendor side to work with Integrated Software Solutions, Inc. (ISSI), where she eventually became the Executive Vice President, Sales and Administration. During her time at ISSI, Werner consulted with over 100 different associations, advising on business practices and implementation and better use of association management software system and accounting system to run their organizations more efficiently. Werner holds a Bachelor’s Degree in Economics from Denison University.

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Protecting Patient Data in the Electronic Age: Updating 42 CFR Part 2 The law, 42 U.S.C. §290dd-2 Confidentiality of Records, generally referred to as 42 CFR part 2, or part 2 was enacted in the early 1970s. The last time the rules were substantially changed was in 1987. The rules did not envision a time when records were maintained elec­tronically, would be transferred via the internet, and when treat­ment for substance use disorders would be a routine part of care in primary care settings.

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By Kimberly Johnson, PhD, Director, Center for Substance Abuse Treatment (CSAT ), Substance Abuse & Mental Health Services Administration (SAMHSA)

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doption of Electronic Health Records (EHRs) is now nearly universal in hospitals in the United States.1 Primary care practices are not far behind with 87% having adopted an EHR, most of which are certified EHRs.2 Behavioral health providers are far behind, but catching up with 79% of mental health agencies using an EHR in 20143 and 53% of substance use disorder specialty treatment agencies using an EHR in 2015.4 While most primary care and hospital programs report that they cannot or do not transmit data to or from behavioral health organizations electronically (11% of physician offices, 28% of hospitals),5 in the near future inte­gration of behavioral health into the healthcare system will become the standard and sharing of electronic data on patients to improve care will become an expectation.

It is against this backdrop that Substance Abuse and Mental Health Services Ad­min­is­tra­tion (SAMHSA) undertook updating the rules regarding confidentiality of patient records for the treatment of substance use disorders. The law, 42 U.S.C. §290dd-2 Confidentiality of Records, generally referred to as 42 CFR part 2, or part 2 was enacted in the early 1970s. The last time the rules were substantially changed was in 1987. The rules did not envision a time when records were maintained electronically, would be transferred via the internet, and when treatment for substance use disorders would be a routine part of care in primary care settings. Primary care providers, integrated health systems and payers who manage part 2 data along with other health data have long complained that the 1987 regulations made operating integrated care difficult as records needed to be maintained separately from other health records and could not be submitted to Health Information Exchanges (HIEs) because the consent provisions of the law.

In 2014, SAMHSA held a listening session to solicit feedback about what needed to be changed to update the rules to function in the near future where patient information is shared electronically amongst providers. Approximately 1,800 people participated either in person or via phone and we received 112 verbal and 635 written comments. Based on the listening session, SAMHSA wrote proposed changes to the rules and published a Notice of Proposed Rulemaking (NPRM) in the Federal Register in February of 2016. Comments were due by April 11, 2016. SAMHSA received 376 comments.

After reviewing the written comments and working with other divisions in the Department of Health and Human Services (HHS) and other parts of the federal government, SAMHSA published the final rule on January 18, 2017 with a scheduled effective date of February 17, 2017. By executive order of the President, the rule is under review and its effective date is delayed until at least March 20, 2017.

The final rule as published on January 18, 2017 has several changes that are important for clinicians to know and understand. The most important of these is changes to the requirements for consent to share records. The new rule allows for a 22

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general designation in the “to whom” section of the consent form. For example, a patient could now sign consent for “all my treating providers” and XYZ Health Information Exchange (HIE) so that records that include part 2 information could be shared via an HIE with anyone that treats that patient as are other types of health information. Patients may sign a general release in a primary care setting prior to receiving care for a substance use disorder and may not know that unless they change their designation, that information about their treatment for a substance use disorder can be included in all of their health records. Counselors who work with patients who have substance use disorders should make sure that their patients understand what they are signing when they sign a release of information for confidential records and the pros and cons of using a general designation.

Because we did not change the rule in terms of using a general designation in the “from whom” section of the consent form, patients could sign a consent that basically says information could be shared “to all my providers” “from all my providers.” While such consent will facilitate electronic data exchange, the patient should have a full understanding of what that means.

If a patient uses the general designation in the “to whom” section of the consent form under the new rules, they have a right to request and receive a list of who accessed the information about their substance use disorder treatment. Programs may not use the general designation for the “to whom” section of the consent until the system of care in which the information is being shared is capable of providing the list of disclosures.

Also, the consent must specify what type of information can be shared and for what purposes it can be shared. It is important for clinicians to help patients make good choices about their options. For consent to release records to individuals and entities other than health care organizations, the release must be specific to the individual or entity. The rules do not allow for the use of a general designation outside of the healthcare system. For example, for a part 2 program to provide information to a probation officer, the consent must specify the probation officer by name.

Another provision that may be of interest to clinicians is that programs must have in place formal policies and procedures to protect the security of records. The policy and procedure must specify mechanisms by which the organization protects against unauthorized disclosure or use of patient identifying information in both paper and electronic records. The security of records provision includes language regarding how records should be disposed of in the event that a program is closed or merged into another organization. Since so much data is now held “in the cloud,” specific processes for purging electronic records that may be dispersed in multiple places is now necessary to ensure confidentiality.

The new rules clarify that the prohibition on re-disclosing records only applies to part 2 information that would be directly linked to an identifiable individual. For organizations that receive information from a part 2 program and incorporate that information into the electronic medical record, the entire record does not fall under part prohibitions on re-disclosure. Only the information that links the specific patient to the part 2 data is prohibited from re-disclosure. So, for example, a healthcare

system that had part 2 data incorporated into its EHR would be able to release information about part 2 services if the data was de-identified, or it could re-release information about the patient if the part 2 data was removed. All of these releases would be subject to other laws such as the Health Insurance Portability and Accountability Act. Depending on the receiving organization and the purpose of the disclosure, general consent may allow for re-disclosure. The prohibition on re-disclosure provisions assume the patient has not consented to re-disclosure.

There are a number of provisions in the new rules that make accessing and sharing data for research and audit and evaluation purposes easier. Based on comments submitted in response to the NPRM, we went further than we had originally proposed in terms of allowing part 2 data to be linked to other datasets for the purposes of research. At the same time, we also clarified how the researcher needed to maintain and dispose of confidential records. We also clarified that part 2 data could not be shared with law enforcement agencies even for the purposes of data linkages for research.

We clarified that the audit and evaluation exception to consent included audits for the Children’s Health Insurance Program and for evaluation at the Accountable Care Organization (ACO) or similar system level when those activities are required by funders for payment decisions. This was done by clarifying that the Centers for Medicare & Medicaid Services or its agents could conduct audits and evaluations. In addition, on the same day the Final Rule was published, we also issued a Supplemental Notice of Proposed Rulemaking (SNPRM) to address an issue that was raised in comments but not addressed in the initial NPRM. The use of contractors to conduct a variety of activities by health systems (not just individual providers) led to concerns that essential functions could not be conducted by contractors if part 2 data is in the record. Part 2 programs may use a qualified services organization agreement (QSOA) to allow contractors to perform essential business functions, but the QSOA provision was written to support only the part 2 program. A large health system, an ACO or some other entity to which the part 2 program might belong or which might be a lawful holder of part 2 data, and which might conduct activities related to payment and operations via contractors cannot use the QSOA provision. For example, a part 2 program might, with an appropriate consent, provide information to a managed care company for the purposes of payment. If the managed care company used a contractor to conduct any of their operations such as data analysis for rate setting, under the current regulation it is not clear that they are allowed to share the part 2 data with the contractor. The SNPRM proposes clarifying the parameters of sharing data with contractors when the organization that is sharing the data is not a part 2 program. Comments on the SNPRM were accepted through February 17, 2017.

With all of these changes to increase data sharing, it is important to remember the reason the confidentiality law was originally passed. The law was designed to protect people who sought treatment from being at higher risk of prosecution than people who did not seek treatment. It is important to remember that as long as there is illegal drug use, people who have drug use disorders are at risk for prosecution for breaking the law. If the protections provided by 42 CFR part 2 are removed, then their

medical records can be used as evidence against them. Similarly, even people with alcohol use disorders could have their medical records used to prosecute them for other offenses if their records were available to law enforcement.

The changes made in the rules published in January are an attempt to allow for data sharing within the healthcare system so that patient care may be improved by being integrated, and to improve research by ensuring that data about a patient’s substance use and treatment for substance use disorders is not a missing variable in research studies. We retained protection from use of part 2 information about a patient for the purposes of prosecution and prohibitions on sharing the data with law enforcement agencies. It is up to treatment agencies and clinicians to help patients understand the risks and rewards of greater sharing within the healthcare system. While improved care might be an outcome, the risk of accidental unauthorized release is increased as the data is more widely shared. Patients will need to be informed of their right to request a list of to whom their information is provided if they sign a general consent. In this era of big data, it behooves everyone to better understand and consider with whom we share personal information whether it is regarding health care, our activities, our location or our consumer habits. The new rules allow for, but do not require, broader sharing of information about treatment for substance use disorders. Look to the SAMHSA website for future guidance about implementing the new rule and sample consent forms that you may consider using.

REFERENCES 1 JaWanna Henry, MPH; Yuriy Pylypchuk, PhD; Talisha Searcy, MPA, MA; Vaishali Patel, PhD MPH (2016). Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015 ONC Data Brief 35. https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acutecare-hospital-ehr-adoption-2008-2015.php (accessed 2/12/17).

2 Jamoom E, Yang N. Table of Electronic Health Record Adoption and Use among Office-based Physicians in the U.S., by State: 2015 National Electronic Health Records Survey. 2016. https://dashboard.healthit.gov/quickstats/ pages/physician-ehr-adoption-trends.php (accessed 2/12/17).

3 Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2014. Data on Mental Health Treatment Facilities. BHSIS Series S-87, HHS Publication No. (SMA) 16-5000.

Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016.

4 Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2014. Data on Substance Abuse Treatment Facilities. Behavioral Health Services Information System, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

5 Office of National Coordinator. 2016. Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Health Information. https://www.healthit.gov/sites/ default/files/Attachment_1_-_2-26-16_RTC_Health_IT_Progress.pdf (accessed 2/12/17).

Kimberly A. Johnson, PhD, Director, Center for Substance Abuse Treatment, leads the center’s activities to improve access, reduce barriers, and promote high quality, effective substance use disorder treatment and recovery services. Johnson has worked in many areas in the field including as a researcher and educator, an SSA, an executive director of a treatment organization and as a child and family therapist. She has authored a variety of publications including e-health solutions for people with alcohol problems, using mobile phone technology to provide recovery support for women offenders, and new practices to increase access to and retention in addiction treatment. She is co-author of a book on the NIATx Model and co-author of the chapter on quality improvement in the text ASAM Principles of Addiction Medicine. Johnson has a Master’s Degree in counselor education, an MBA, and a PhD in population health.

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Addressing Privacy Concerns to Advance Research

By Jack B. Stein, PhD & Maureen P. Boyle, PhD, National Institute on Drug Abuse (NIDA)

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n addiction science, there is increasing urgency around the question of how to protect the privacy of people with substance use disorders (SUDs) while also ensuring that data on individuals with SUDs are not left out of large-scale research initiatives. Science depends on access to data, and advances in information technology and informatics have revolutionized what can be achieved with healthcare data — from basic research to enabling a learning health system that evolves in real time in response to data analytics and provides clinical decision support at the point of care.

These efforts have tremendous potential to advance our understanding of health and disease and to drive the evolution of the healthcare system. Unfortunately, the important protections around patient data can also create impediments to research that slow progress in learning how best to identify and treat patients with substance use disorders.

SUDs affect an estimated 21.6 million Americans, or 8.2 percent of the population over age 111; apart from their incalculable toll on individuals and their families and loved ones, SUDs cost society many hundreds of billions

of dollars each year in healthcare and criminal justice costs2.

They also have direct impacts on physical health status through the deleterious effects of drugs and alcohol on multiple organ systems, as well as the potential interactions between medications and recreational drugs3. Indirect effects on physical health are also often seen since compliance with treatment can be compromised in persons suffering with behavioral health disorders4.

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How can we balance the need to protect patient privacy with the need to ensure that SUD data are meaningfully included in large-scale analyses of health data?

While ensuring adequate insurance coverage and enforcing parity protections are critical for improving access to and quality of SUD treatment, research indicates that insurance coverage is not the only barrier to engaging people with SUDs in treatment, and this highlights the importance of privacy protections5. Maintaining strict confidentiality in the provider-patient relationship has always been a cornerstone of clinical practice, and privacy and confidentiality are even more important for individuals with SUDs than with other conditions. Seeking treatment for illicit drug use or the medical consequences of substance misuse could potentially expose a patient to legal consequences such as arrest or losing custody of a child. In addition, people with SUDs are still stigmatized due to the lack of understanding of the medical nature of their condition, including changes in the brain that make it difficult for an individual with an SUD to weigh the consequences of their actions. Thus, seeking treatment can also have social and employment consequences as well as legal ones.

In order to avoid systematically excluding one of the most vulnerable populations served by the healthcare system, it is critical that research efforts include both physical and behavioral health data on patients with SUDs. However, privacy and confidentiality laws pose challenges to including mental health and substance use disorder (SUD) treatment data in large-scale research projects. This has the potential to have profound negative consequences for the field and for patients suffering with behavioral health disorders.

Privacy protections for data on SUD care were written into federal statute and codified as regulations in 42 CFR Part 2 (Part 2) in 1975 to combat the effect that the negative consequences mentioned above were having on the willingness of people with SUDs to seek treatment. Part 2 was recently updated “to ensure that patients with substance use disorders have the ability to participate in, and benefit from health system delivery improvements, including from new integrated health care models while providing appropriate privacy safeguards.” However, implementation is currently on hold, along with other recent regulations6.

Implementation of the Final Rule, published on January 18, 2017, will not occur before March 21, pending review by the new Administration.

Regardless of whether the update to Part 2 is implemented, it is important to ensure that individuals with SUDs are able to benefit from the scientific advances that come from large-scale research projects. Both the current and the proposed final rule have specific requirements for patient consent, but notably, sharing data with qualified researchers for research purposes without patient consent

is allowed. It is important to note that many states also have privacy laws to protect data on SUD treatment, but these rules do not prohibit the sharing of data for research; rather, they set the standards for how information can be shared.

These privacy rules also permit data sharing for the purpose of treatment coordination if consent requirements are met. However, people with SUDs can be left out of delivery system transformation efforts that could improve care for individuals with SUDs if healthcare systems allow these privacy protections to hinder information sharing. Many developments in the past several years are improving the integration of addiction screening and treatment into the wider healthcare system, including ambulatory primary care and emergency medicine. This includes wider utilization of effective medications for opioid use disorders such as buprenorphine, which can be administered by licensed clinicians and even effectively initiated in emergency room settings7.

Preparing for the hurdles associated with the federal and state privacy laws is critical to ensure inclusion of behavioral health data. For example, in 2009, the American Recovery and Reinvestment Act (ARRA) provided funding to develop health information exchanges (HIEs) across the country, intended to foster sharing of patient clinical records between different healthcare providers to support improvements in healthcare integration.

Because of the short timeline for expending the appropriated funds, the complexities associated with incorporating behavioral health data while complying with existing privacy protections were not addressed in the initial implementations. As a result, the vast majority of HIEs were set up without the ability to share data from specialty behavioral health treatment organizations, including SUD treatment facilities. While initially there may have been an intention to retrofit the technology infrastructure to support inclusion of behavioral health data, it has generally been found that compliance with the privacy laws could not be achieved without enormous expense. As a result, only a very small minority of HIEs currently include behavioral health treatment data, presenting a major impediment to effec­ tive integration of behavioral health and general healthcare services8.

The exclusion of individuals with SUDs from delivery system transformation efforts continues to be problematic, and the potential exclusion of individuals with SUDs from large-scale research projects is also deeply troubling. If the research that will become the basis for future development and implementation of evidence-based practices excludes individuals with SUDs, the dataset and the resulting research will be biased. If their data are excluded, patients suffering with SUDs — a particularly vulnerable population that already experiences significant health disparities9 — may be excluded from the potential advances that are to be reaped from data-driven initiatives10. Further, studies of other health conditions will not adequately account for how best to treat people with comorbid SUDs. For example, in order to comply with the federal SUD treatment confidentiality regulations, research datasets from the Centers for Medicare & Medicaid Services (CMS) do not include SUD treatment data, which equates to approximately 4.5% of inpatient Medicare claims and approximately 8% of inpatient Medicaid claims. As described recently in the New England Journal of Medicine, this omission affects crucial research to evaluate policies and practices related to care for patients with addiction.

Also, most of the suppressed data concerns claims for which a SUD was a secondary diagnosis, thus its impact extends to other disorders11.

Since behavioral health problems disproportionately affect populations who are already vulnerable and underserved due to economic disadvantage, age, and other factors, it is crucial to incorporate behavioral health information into the data-driven efforts of coming years. If research activities and investments exclude individuals with SUDs, this can bias results and worsen existing disparities, since any research results that are translated into practice will not account for the needs of individuals with SUDs. The question remains: How can we balance the need to protect patient privacy with the need to ensure that SUD data are meaningfully included in large-scale analyses of health data? Answering this will become increasingly important in coming years.

REFERENCES 1 Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. (2014). at http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/ NSDUHresults2013.pdf.

2 U.S. Department of Justice National Drug Intelligence Center. National Drug Threat Assessment 2011. (2011). at http://www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf.

3 Lindsey, W. T., Stewart, D. & Childress, D. Drug interactions between common illicit drugs and prescription therapies. Am. J. Drug Alcohol Abuse 38, 334–343 (2012).

4 Herbeck, D. M. et al. Treatment Compliance in Patients with Comorbid Psychiatric and Substance Use Disorders. Am. J. Addict. 14, 195–207 (2005).

5 Saloner, B., Bandara, S., Bachhuber, M., Barry, C.L. Insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders.

Psychiatric Services. 2017. 10.1176/appi.ps.201600182. [Epub ahead of print].

6 U.S. Government Publishing Office. Electronic Code of Federal Regulations: Title 42, Chapter 1, Subchapter A, Part 2. (2017, February 7). at http://www.ecfr.gov/cgi-bin/text-id x?rgn=div5;node=42%3A1.0.1.1.2.

7 D’Onofrio, G., O’Connor ,P.G., Pantalon, M.V. et al. Emergency department-initiated bupre­ norphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44.

8 SAMHSA-HRSA Center for Integrated Health Solutions. The Current State of Sharing Behavioral Health Information in Health Information Exchanges. (2014). at http://www. integration.samhsa.gov/operations-administration/HIE_paper_FINAL.pdf.

9 Kessler, R. C. Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results From the National Comorbidity Survey. Arch. Gen. Psychiatry 51, 8 (1994).

10 J. David Hawkins et al. Unleashing the Power of Prevention. (2015). At http://www.iom. edu/~/media/Files/Perspectives-Files/2015/DPPowerofPrevention.pdf.

11 Frakt, A. B. & Bagley, N. Protection or Harm? Suppressing Substance-Use Data. N. Engl. J. Med. 372, 1879–1881 (2015).

Jack Stein, PhD, MSW, joined the National Institute on Drug Abuse (NIDA) in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.

Maureen Boyle, PhD, is the Chief of the Science Policy Branch in NIDA’s Office of Science Policy and Communications where she works with congress and other stakeholders to promote science based decision making in public health policy. Prior to joining NIDA, Boyle was a Lead Public Health Advisor at the Substance Abuse and Mental Health Services Administration (SAMHSA) where she coordinated efforts to promote the use of technology to improve the delivery of behavioral health care. Boyle received her PhD in neuroscience from Washington University in St. Louis where she studied the genetic and molecular basis of depression and anxiety-related behaviors. She completed a postdoctoral fellowship at the Allen Institute for Brain Science and she received training in science policy through the American Association for the Advancement of Science Science and Technology Policy Fellowship program.

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Clinical Supervisors: How Well Do You Know Your Ethical Obligations?

By Thomas G. Durham, PhD, NAADAC Director of Training

SITUATION 1: A counselor you supervise has a client who has difficulty getting to the clinic for outpatient sessions every week due to transportation problems. Unbeknownst to you, the counselor has previously, on occasion, provided clinical sessions over the internet using one of the more commonly used free platforms for face-to-face communication. However, this particular platform is not secure and thus does not protect the information shared during the conversations. The counselor was very proud of what he or she saw to be a creative way to conduct therapy, but did so without discussing this with you; nor did the counselor ensure that the method used met all confidentiality regulations.

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SITUATION 2: Another supervisee was assigned a case of someone known to him or her (not a close friend but an ­acquaintance). This was not brought to your attention at the onset of the assignment; in fact this did not become ­apparent until your supervisee was seeing this person for ­several weeks (and had developed what appeared to be an effective clinical relationship). As it turns out, this client is a friend of the supervisee’s spouse and there is a rare chance they could see each other at s­ocial events.

The supervisee sees nothing out of the ­o rdinary, but felt it necessary to inform you since one of these encounters occurred during the last week.

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oth of these situations have at least one thing in common: the supervisor was initially unaware of a situation that had ethical ramifications. The work of addiction professionals can be a challenging journey with surprises that may appear at any turn. Counselors can be suddenly caught off guard and may react by instinct without thinking things through. Ethical decision-making is a continual and active process as clinicians are faced with ethical dilemmas daily, and without proper training or guidance, one is at risk for making decisions that take him or her down the wrong path. Thus, the clinical supervisor plays a vital role, not only in maintaining awareness of what is going on with each case, but in teaching, mentoring, and modeling ethical decision-making as a component of the supervisee’s ethical and professional growth.

Supervisory Roles and Responsibilities Clinical supervisors are continually faced with ethical obligations in their supervisory roles and must be readily available to provide guidance and support to counselors who face decision-making dilemmas. As a component of supervisory guidance, perceptive clinical supervisors help counselors recognize these dilemmas when they occur and mentor them in developing a framework of ethical decision-making. Underlying this obligation is the expectation that supervisors are knowledgeable and skilled in the practice of clinical supervision. Supervisory training is addressed in the NAADAC/ NCC AP Code of Ethics (2016): “Addiction Professionals shall complete training specific to clinical supervision prior to offering or providing clinical supervision to students or other professionals” (Principle VII-2). Without such training, supervisors will likely lack the skills necessary to ensure the effective and ethical performance of their supervisees and may be at risk for being vicariously liable for the actions of supervisees (Corey, Corey, Corey, and Callanan, 2015).

Clinical supervisors take on multiple roles, each of which has the potential of providing significant influence in the supervisory relationship (and as I often say when training supervisors, “It’s all about the relationship”).

This may include the roles of teacher, consultant, coach, evaluator, role model, advocate, or variations and/or combinations of these noteworthy relational components. As a relationship is formed through any of these roles, a primary obligation of the clinical supervisor is to ensure the supervisee delivers counseling services that are effective and within the bounds of ethical standards. With this in mind, I consider, as a primary goal of clinical supervision, the promotion of independence and autonomy by the supervisee. When I conduct clinical supervision training, I often ask supervisors to consider, as an ultimate by-product of professional development, the supervisee’s ability to “self-supervise.” Of course, this does not mean that when one reaches this point, he or she can go without any supervision.

What it does mean, however, is that the supervisee has reached a point of autonomy where he or she is making accurate and effective decisions regarding client care. When a counselor has reached this level of growth, he or she will likely have also developed an ability to “think ethically.”

Teaching Ethical Decision-Making One means of guiding counselors in their development of a framework for ethical decision-making is to pose a series of questions that have the intent to increase a counselor’s awareness of his or her ethical responsibilities. These are questions that address what many believe to be the four primary principles of biomedical ethics. These principles, applicable to all helping professions, are: autonomy, beneficence, non-malfeasance, and justice (Beauchamp & Childress, 2012). Note also that these four principles are included among a list of 17 items in the NAADAC/NCC AP Code of Ethics (2016) that counselors are recommended to follow when making ethical decisions.

The questions that address these four principles are: 1. Is the counselor giving the client the freedom to make choices about his or her direction in treatment? (autonomy) 2. Is the counselor providing hope, encouragement, and support for the client’s decisions that are individualized, in line with the client’s values, and in the client’s best interest regarding change toward successful recovery? (beneficence) 3. Is the counselor working with the client in a way that will “do no harm”? (non-malfeasance) 4. Are ethical codes, laws, and universal values being followed by the counselor and is the counselor providing fairness to all that are involved with this client’s treatment? (justice) You might also want to take a look at the other 13 principles listed in the NAADAC/NCC AP Code of Ethics (2016) and come up with similar questions for each one. Posing these or similar questions not only gives the supervisor valuable information about a counselor’s work with a client, but can also be a catalyst in promoting ethical thinking by the counselor. Supervisors both must be aware of what is occurring in the sessions conducted by supervisee, and are obligated to make sure what is occurring is ethically sound and clearly understood by the counselor.

Such awareness not only ensures client welfare, but it also protects the supervisor and the agency from being held liable for any negligence of the part of the counselor.

It is important to note that the supervisor and the agency may be held liable for damages, solely as a result of the supervisory relationship, occasioned by the professional negligence of a supervisee. According to Falvey (as cited by Bernard and Goodyear, 2014), three conditions must be established that clarify the existence of a legal supervisory relationship: 1) the supervisee agrees to work under the direction and control of the supervisor; 2) the supervisee is acting according to a defined set of duties and tasks expected by the supervisor; and 3) the supervisor has the authority to control the work of the supervisee.

An important factor that would determine supervisor liability is whether or not the action in question falls within the scope of the supervisory relationship (Bernard and Goodyear, 2014). In other words, if the act occurred outside of the place of work and the supervisor did not have any reasonable expectation that the supervisee would commit the act under question, then the supervisor would not likely be held liable.

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Most clinical relationships in licensed or accredited treatment programs meet the conditions of legal supervisory relationships. If these conditions are met and the supervisor is not aware of what is going on between the counselor and client, when professional negligence occurs, the supervisor could be found to be vicariously liable in a malpractice suit.

The key to protection against vicarious liability is to have proof (through documentation) that clinical supervision is regularly occurring and that the material discussed in supervision follows ethical and legal guidelines that will promote professional growth for the supervisee and, most importantly, the welfare of the clients being treated. Most instances of a supervisor being named in a malpractice suit occur when negligent acts of a supervisee are performed within the scope of the supervisory relationship (Bernard and Goodyear, 2014). For instance, the negligence may have occurred without the supervisor’s knowledge and, thus, the supervisor was unable to prove (through documentation) that a reasonable effort to supervise was made.

An example of not making a reasonable effort to supervise is merely (and occasionally) providing administrative oversight of a counselor’s work.

Modeling Ethical Behavior As noted previously, clinical supervision is all about the relationship. Without an effective working relationship that comes with “making a reasonable effort to supervise,” supervisees are left fending for themselves, which leaves all involved (the counselor, the supervisor, and the agency) in a tenuous position with regards to ethical conduct. On the other hand, the supervisor who provides ongoing and effective clinical supervision will be in an excellent position to foster the professional development of the supervisee.

A key component of such development is the modeling of ethical behavior by the supervisor. Modeling by the supervisor (and hence observation by the supervisee) can be a powerful means promoting ethical behavior (Bernard & Goodyear, 2014).

In supervision, we often talk about “parallel process.”

The classic definition of a parallel process is when a counselor’s conduct parallels that of his or her client in the supervisory relationship (as “upward” parallel process).

However, effective modeling by the supervisor is an example of “downward” parallel process. In either direction, the parallel process usually occurs in mentoring relationships where one subconsciously begins to take on certain

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aspects of his or her mentor’s professional behavior. When supervisors form a respectful working relationship with supervisees, the actions of the supervisor become significant (either consciously or unconsciously) to the supervisee.

Supervisors are continually modeling behavior. Depending on what kind of behavior they are modeling, this can have a significant impact on learning by the supervisee. The best way to model ethically sound clinical skills is to do co-therapy with supervisees. Co-therapy in supervision provides two simultaneous supervisory methods: observation of the counselor’s skills and modeling by the supervisor.

In other words, if the act occurred outside of the place of work and the supervisor did not have any reasonable expectation that the supervisee would commit the act under question, then the supervisor would not likely be held liable.

Multiple Relationships Another area of concern that can occur in both the clinical realm as well as within clinical supervision is the formation of multiple relationships. According to Bernard and Goodyear (2014), “multiple relationships occur when people have more than one social role in relationship toward each other” (p.259). Multiple relationships are problematic when either of two things occur: when there is a power differential (as in the case of a counselor-client relationship or a supervisor-counselor relationship) and when the focus of the primary relationship is at risk of being super ceded by another relationship (such as a social relationship).

In both clinical and supervisory relationships, boundaries exist that can prevent multiple relationships. Of course, the boundaries in the counselor-client relationship are more firmly established and more clearly defined than those in the supervisor-supervisee relationship, but boundaries in both must be identified and respected. Not all boundaries in a supervisory relationship are problematic, but they can become problematic when, by crossing such boundaries, the view of the individuals in the relationship become clouded. Issues such as favoritism, exploitation, or avoidance of the primary relationship can put the counselor at great risk of harm by the supervisor. Some multiple relationships in supervision cannot be avoided (being promoted to a position of supervising a former peer or friend), but others must be avoided (forming a sexual relationship or allowing supervision to slip into therapy). Competent therapists and supervisors know how to avoid multiple relationships. Astute clinical supervisors also model such behavior and bring discussions of possible multiple relationships into supervisory sessions.

Competence Besides competency in knowing how to avoid or manage multiple relationships, competence is another ethical principle that pervades both counseling and clinical supervision. The primary issue of competence as an ethical issue is described in Principle III-14 in the NAADAC/ NCC AP Code of Ethics (2016). This principle addresses the ethics of practicing within the boundaries of one’s level of competence. This ethical principle also recognizes that competence is established thought education, skill development, experience, and professional credentialing. Perceptive supervisors remain aware of the level of competence of supervisees and ensure that the clinical work of counselors under their supervision match their level of competence. This principle also includes the work of clinical supervisors who must be competent, not only as supervisors, but in the specific areas in which their supervisees are working (Corey, et al., 2015).

The latter becomes a problem in addictions treatment when the supervisor (however skilled he or she might be in counseling) lacks a foundation in working with clients who are diagnosed with substance use disorders.

Also, it is quite common that those who become supervisors are promoted without previous supervisory experience. Therefore, to stay within ethical guidelines, newly promoted supervisors must develop supervision-specific competence through training and supervision of their supervision (Bernard & Goodyear, 2014). Those who do not seek such means of developing supervisory competence are not only violating an ethical code, but they are doing disservice to those being supervised and ultimately to the clientele their supervisees are working with.

Confidentiality When we think about ethical obligations, the area that comes to mind for most is confidentiality. This is the area that is frequently identified by clinicians as being ethically problematic (Bernard & Goodyear, 2014).

Confidentiality is specifically covered under Principle II in the NAADAC/ NCC AP Code of Ethics (2016). I encourage clinical supervisors to become familiar with the 28 items listed under the NAADAC/ NCC AP Code as well as the Code of Federal Regulations (42 C.F.R. Part 2), the Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH). Note that the latter (HITECH) was passed to widen the scope of privacy and security protection under HIPAA regarding the protection of confidential information that is transmitted via digital technology (Rousmaniere, Abbass, & Frederickson, 2014).

We are entering a new world of technology with regards to the means available to provide clinical work and clinical supervision outside of traditional face-to-face interaction. For instance, technology-based clinical supervision is being introduced as a means of allowing supervisors to engage in key elements of clinical supervision (such as direct observation, skill building, and evaluation) while in a different location than the counselor. This opens up many possibilities of new means of providing clinical supervision; however, it also opens up a broad area of concern around the security and protection of confidential information. For instance, there is an increasing number of platforms available for interactive audiovisual technology (IAVT), but not all are HIPAA or HITECH compliant (Rousmaniere, et al., 2014).

I encourage supervisors to expand their repertoire of methods for delivering clinical supervision, but when doing so, one must ensure that the transmission of the chosen platform is encrypted as a means of avoiding access by others to confidential information. Not all popular means of electronic meeting platforms are encrypted. Moreover, some common videoconferencing platforms can be used for conversations between

supervisors and supervisees, but are not appropriate for any transmission of protected information. If videoconferencing is used to share videos of client sessions or the sharing of any confidential information via live supervision, a fully-vetted and encrypted HIPAA and HITECH-compliant platform must be used. Ethical principles such as informed consent, vicarious liability, multiple relationships and confidentiality all come into play when we consider new technologies. This new era of online therapy and the use of electronic transmission in counseling and clinical supervision brings great potential for expanded and efficient services. However, we must be vigilant in following all ethical guidelines.

Conclusion Counselors are faced with ethical dilemmas daily, but unfortunately some counselors are ill equipped to meet the many demands encountered in addiction counseling. One means of ensuring ethical conduct (for both supervisee and supervisor) is to review the NAADAC/ NCC AP Code of Ethics (2016) as a component of clinical supervision. This can be accomplished, for example, by focusing on one principle at a time and applying each one to case studies or actual examples from the supervisee’s practice.

Ethical dilemmas occur in the supervisory realm as well. By having a firm grasp of ethical principles, the supervisor effectively serves as a professional role model to supervisees. However, if a supervisor continues to juggle multiple demands and responsibilities and, as a result, is pulled away from providing adequate clinical supervision, there is a risk that the counselor, supervisor, and ultimately the treatment agency can be held liable for negligence. Situations like the two examples at the beginning of this article are not uncommon. They can be avoided or effectively managed when supervisors remain aware of the salient aspects of a supervisee’s case load.

It is also crucial that counselors and supervisors have a firm grasp of ethical codes and boundaries. Situations like the case studies that appear at the beginning of this article underscore the importance of regularly scheduled and ongoing supervision. As a supervisor, you must count on counselors you supervise to be able to “think ethically.” This can be accomplished when supervisors remain consistently aware of a supervisee’s work with clients while maintaining, at a minimum, a “reasonable effort to supervise.”

REFERENCES Beauchamp, T.L. & Childress, J.F. (2012). Principles of biomedical ethics (7th ed.). New York: Oxford University Press.

Bernard, J.M. and Goodyear, R.K. (2014). Fundamentals of clinical supervision (5th ed.). Upper Saddle River, NJ: Pearson.

Corey, G., Corey, M.S., Corey, C., and Callanan, P. (2015). Issues and ethics in the helping professions (9th ed.). Boston: Cengage Learning.

NAADAC. (2016). NAADAC code of ethics. Alexandria, VA: Author.

Rousmaniere, T., Abbass, A., and Frederickson, J. (2014). New developments in technologyassisted supervision and training: A practical overview. Journal of Clinical Psychology, 7(11).

1082–1093.

Thomas Durham, PhD, LADC, has been in involved in the field of addiction treatment since 1974 as a counselor, clinical supervisor, program director, and educator. As Director of Training at NAADAC, he is responsible for the assessment, coordination, curriculum development, and delivery of training. Durham is also an adjunct faculty member at Northcentral University where he teaches graduate courses in psychology. Prior to joining NAADAC, he worked in government contracting under SAMHSA (while at JBS International) and the Department of Defense (while at Danya International).

He also served as the Executive Director of The Danya Institute and Project Director of the Central East Addiction Technology Transfer Center. A seasoned curriculum developer and trainer, Durham has been conducting training for over 25 years on a variety of topics on the treatment of addictions including motivational interviewing, co-occurring disorders, and clinical supervision. He holds a PhD in Psychology from Northcentral University, a Master of Arts degree in Counseling Psychology from Adler University, and a Bachelor of Arts degree in psychology from DePauw University.

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Predatory Patient Recruitment: Waste, Fraud, and Abuse

By H. Westley Clark, MD, JD, MPH, Dean’s Executive Professor of Public Health, Santa Clara University, Santa Clara, California

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iscrimination, shame, and stigma adversely affect how many of those in the throes of addiction see themselves. Laws, regulations, and social customs influence how society responds to those deemed “drunks” and “drug addicts.” It is well understood that substance use disorders (SUDs) can cause substantial psychosocial decrements of function, such as family discord, domestic violence, child abuse and neglect, poor job performance, loss of housing, health problems including psychological problems, and a host of other phenomena that erode the functioning of an affected individual.

Thus, because of these complexities, those experiencing alcohol and drug use disorders are especially vulnerable. The Centers for Disease Control and Prevention (CDC) has declared opioid misuse to be an epidemic and the attendant increase in opioid overdose deaths has further heightened the public’s awareness of the perils of prescription opioid and heroin use.

Unfortunately, the vulnerability of those with substance use disorders also creates an opportunity for exploitation.

How We Got Here: History of SUD Treatment & Surrounding Legislation The exploitation of those with SUDs stems from efforts to get treatment as a result of demands from the criminal justice system’s diversion programs or sentence mitigation programs, or as a result of friends, family, or employers. Historically, access to treatment was a rate limiting step in the provision of care. However, in the past nine years, conditions have changed.

With the influence of the Affordable Care Act (ACA), the substance use disorder treatment field has become a billion-dollar industry. The ACA made mental health and addictions services essential health benefits required to be covered by health insurance plans. In addition, the Mental Health Parity and Equity Act (MHPEA) also required mental health and addictions services to be treated more equitably by insurers. The combination of the MHPEA and ACA extended overall health coverage to more people, expanded the scope of coverage to include mental health and addiction benefits, and improved the coverage provided through those benefits.

In addition, federal spending on opioid use disorders has experienced a surge in funding through the 21st Century Cures Act, which authorized the spending of a billion dollars spread out over two years for medication assisted treatment (MAT).

An unsavory side effect of increased awareness and concern and increased financing has been the entry into the SUD treatment field of practitioners who are willing to engage in predatory practices, including illegal and unethical activities. Those with SUDs have become a commodity, a means to the end of quick profits or higher profits, rather than an end in and of themselves. The business of SUD treatment has catapulted ahead of the treatment of those with SUDs. When business becomes the purpose of substance use disorder interventions, the ethics of clinicians and providers become tested.

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Ethical Considerations & Resulting Care The growth of the business of SUD treatment has resulted in questionable behavior associated with the business of substance use disorder treatment and recovery. Patient solicitation strategies that involve robo-calls, promises of cures, inappropriate advertisements, referral bounties, travel incentives, and kickbacks are problematic. If treatment programs increase their emphasis on these types of strategies to enhance patient recruitment, particularly patients in other jurisdictions, resources must be shifted from patient management and counseling.

As explored by a New York Times article in August of 2016, treatment centers from around the country were engaged in the poaching of patients from treatment centers in Staten Island, NY, using the solicitation of patient referrals, often with the offer of thousands of dollars.1 The treatment centers seeking referrals used patient recruiters in an effort to fill their beds and to cash in on the increased funding made available by MHPEA, the ACA, and now the 21st Century Cures Act. Notably, this poaching-like referral system does not involve mere referrals from non-SUD oriented programs or from programs that do not have the level of sophistication that a higher-level treatment program might have, nor does it involve decisions to alter care based on the needs of the person under care. Issues of appropriate specialty care, such as care for women with children, senior citizens, LGBT clients, clients with special diagnostic needs, or clients with special psycho social needs, are not subsumed under a discussion of predatory behavior or fraud and abuse. There is no question that some people may need an orthodox referral, some people may need to be transferred from one facility to another, and some people may need a different level of care than can be provided by a single provider.

The problem occurs when profit alone drives clinical decision-making, and the patient becomes the victim of inappropriate care, inadequate care, or even unnecessary care. The problem with unorthodox SUD treatment programs extends from recruitment from the streets to detoxification, from detoxification to acute treatment centers, from acute treatment to longer term treatment, and from longer term treatment to residential treatment and recovery programs. As a result, there has been an increase in both federal and state investigations into the practice of SUD treatment programs of all types.

Viewed in the best light, treatment providers are simply trying to stay in business by maintaining what they determine to be a viable census, whether it is the number of beds filled or clients served in order to stay in business. Viewed from another angle, however, it might appear that “heads and beds” are more important than appropriate care and quality of care.

Motive may matter, but that is often hard to determine. Unfortunately for those seeking treatment, the media has had no shortage of nefarious providers who engage in what could be called predatory patient recruitment to highlight.

Bad Practices: Acts Undertaken by SUD Programs The media has profiled and continues to profile allegations of improper activities associated with SUD programs. One article noted that, “to get addicts to enroll, treatment center operators pay case-management fees that they say require sober home operators to complete specific, critical duties. Prosecutors allege the duties mask the true intent behind the payments — to provide the treatment center with a steady stream of insured addicts.”2 This article revealed a case of a sober living home operator who was arrested for allegedly accepting kickbacks from a treatment program to enroll insured addicts in their treatment program.

Yet another scheme that exploited the availability of funds to treat those with SUDs targeted high school and middle school students. A program that was setup to help youth in recovery became a cash cow by billing for services provided to students who did not have a substance use disorder, billing for counseling sessions that were not conducted, and falsifying treatment plans, group counseling sign-in sheets, and progress notes.3 The Department of Justice issued a press release that stated, “For counselors and supervisors to risk stigmatizing students as substance abusers, as alleged in this case, just to enrich themselves at taxpayer expense is outrageous.”

The tenor of the statement underscores society’s views of those with SUDs. The author of the quote acknowledged not only fraud and abuse, but the stigma of being labeled a person with an SUD as part of the outrageousness of the behavior of the counselors involved in the scheme. It is this jaded view of addiction which imposes on those who serve those who suffer from SUDs a duty of beneficence and stewardship.

Another example of questionable behavior associated with profit rather than progress can be found in the State of Washington, where it was alleged that several counselors at a program were accepting bribes from clients to fake treatment records that were sent to courts on behalf of their clients.4 Clearly, trust is an essential component of treatment. Once clients conclude that the ethics of a counselor or a program are compromised, treatment and recovery becomes a con game, where duplicity and manipulation are the prevailing attitudes rather than honesty and candor.

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concluded that those suffering from SUDs are more deserving of protection than any other vulnerable population. However, those seeking treatment, in treatment, and in recovery are receiving less government protection than other vulnerable populations. For example, in Los Angeles, an owner of a sober living facilities was arrested for sexual abuse, sexual exploitation, and furnishing controlled substances to female patients.5 Predators and those engaged in criminal enterprises see the SUD field and its population as fertile ground for the taking.

Government Involvement The questionable behaviors exhibited by SUD treatment facilities have not gone unnoticed by local and state governments. In California, the owners of sober living facilities were charged with felony counts of grand theft, identity theft, and conspiring to defraud patients and insurers out of more than $176 million; the complaint alleges that “vulnerable people addicted to drugs and alcohol” were lured to sober living facilities with a variety of marketing schemes.6 California is not the only state grappling with the issue of patient brokering, predatory referrals, and fraud and abuse. In December 2016, the a Grand Jury in Palm Beach, Florida issued a report addressing what it saw as, “the proliferation of fraud and abuse occurring within the addiction treatment industry.”7 The Grand Jury had five major areas of concern: (1) marketing; (2) commercial group housing designed for persons in recovery; (3) the ability of the Department of Children

and Families to take action; (4) the strength and clarity of the patient brokering statute; and (5) law enforcement’s ability to take action. The Grand Jury found that the main criminal and regulatory violations occurring within Florida’s substance use disorder treatment industry involved deceptive marketing, insurance fraud, and patient brokering.

The Grand Jur y concluded that deceptive marketing should be strictly prohibited and that material misrepresentions should be punished criminal sanctions, treatproviders should be held able for the conduct of ers they employed, and admissions personnel contact with people with 32

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licensed or certified to ensure that they possess minimum education, training, and experience. In addition, the Grand Jury also recommended licensing for certain types of commercial recovery housing, prohibiting treatment providers from referring patients to any uncertified recovery residences, and prohibiting treatment providers from accepting referrals from uncertified recovery residences.

In 1993, Texas set limits on conditioning employee relationships on patient revenue tied to the number of patient admissions or the number or frequency of telephone calls or other contacts with referral sources to solicit patients for the treatment facility. This same Texas law also spells outs standards for a qualified referral service.8 With federal authorities like the fraud units of the Federal Bureau of Investigation (FBI) and Centers for Medicare & Medicaid Services (CMS), and state and local authorities looking into the predatory practices of detoxification units, treatment programs, residential programs and sober houses/recovery homes, it is important for the substance use disorder treatment and recovery communities to recognize that much is at stake. With a new administration in Washington, DC, and with the Affordable Care Act under scrutiny for change, disruptive processes are in the offing. Fraud and abuse are areas where quick money can be made, but at the expense of people who suffer from substance use disorders. The federal government relies on the False Claims Act, Anti-Kickback Statute, Physician Self-Referral Law, the Social Security Act and the United States Criminal Code to address

fraud in the health care sector.

The larger issue should not be which governmental agency is looking at the practices of any given program, but rather the ethical obligation of treatment and recovery providers to those who present for care.

Unwarranted Consequences: Stigmatization of Felony Convictions tawith ment accountthe marketmarketing and who have direct SUDs should be

The scandals issuing from the proprietary SUD market have cast a shadow on those who have been involved in the criminal justice system.

The phrase “ex-felons” is used repeatedly by the media when describing the inappropriate and illegal activities of those SUD-related activities undertaken by a number of individuals who have run afoul of the law.

While ex-felons may have been involved in some of these machinations, all ex-felons should not be tainted. However, regulatory bodies may be inclined to forbid those with histories of felonies or misdemeanors from owning a recovery home or engaging in the provision of treatment or

recovery activities. This would be a mistake because it further stigmatizes those who are trying to rebuild their lives. Nevertheless, the optics of the situation do create a conundrum for patient advocates and regulatory bodies. Licensing, audits, and hotlines can be used to monitor both treatment programs and recovery homes. Those with non-violent felonies should be treated differently than those with convictions of violence. Those convicted of financial crimes are obviously in a vulnerable position, given the temptations associated with the promise of quick cash from insurance and from clients. Those convicted of crimes of trust may have to have more time to establish their commitment to honesty.

Ethical Guidance by NAADAC and Other Organizations NAADAC, as an organization, has committed its members to an ethical framework in its NAADAC/NCC AP Code of Ethics that includes nine principles, each with subsets.9 Principle I addresses a spectrum of issues associated with the counseling relationship, from client welfare to even virtual relationships. Principle I-41 addresses the issue of uninvited solicitation of potential clients. Principle III-5 states that, “Addiction Professionals shall not participate in, condone, or be associated with any form of dishonesty, fraud, or deceit.” NAADAC also recommends 17 other ethical standards when making ethical decisions — these include the core bioethics principles of autonomy, beneficence, and justice.

NAADAC is not the only organization committed to the ethical practice of treatment and recovery. The American Society of Addiction Medicine (ASAM) supports a body of ethical statements that begin with providing competent medical service with compassion and respect for human dignity.10 ASAM’s statements also includes caveats against conflict of interest and an advantage of power over the patient outside of the treatment relationship. Nevertheless, the ASAM approach asserts that some dual role relationships with patients may not be frankly unethical, simply fraught with potential dangers and conflicts.

Moving from clinicians to providers, the National Association of Addiction Treatment Providers (NAATP) also has a code of ethics.11 NAATP’s code specifically addresses the issue of marketing. It includes provisions about prohibiting financial rewards for patient referrals, deceptive or misleading advertising or marketing practices, and exploiting clients’ right to privacy for the purpose of promoting or marketing their programs.

Some addiction treatment organizations, apart from NAATP, have embraced an Addiction Treatment Marketing Organization (ATMO) code of conduct. Thirteen organizations have signed this code of conduct.12 ATMO describes some common forms of unethical marketing practices as: (1) lead selling/buying or incentivized referrals; (2) misrepresentation of services; (3) misleading information; (4) discussing clients without explicit consent (HIPAA and/or 42 CFR Part 2 violations); (5) inappropriate use of clients for promotional purposes; and (6) ignorance of third-party consultant practices/plausible deniability. The thirteen organizations promulgated nine guidelines that they believe will hold their marketing to a high ethical standard; the only downside is that only thirteen organizations have signed this Code of Conduct.13 The problem with these professional codes of ethics is enforceability.

Because they are largely voluntary, they are virtually unenforceable. To the extent that the organizations that sponsor them simply post them on a website, these codes of ethics may be acknowledged, but ignored.

Clinicians and providers need to be reminded of their ethical obligations to do no harm on a regular basis. When professional organizations fail, then governmental bodies step in and impose laws and regulations in place of

reason and a respect for patients over profits.

While it is not clear what will happen to the ACA under the new political regime, it is clear that governments and insurance companies are not shy about questioning the behavior of clinicians and providers in the field of addictions. Predatory recruitment practices, deceptive marketing, abuse of patients, and insurance fraud only undermine the credibility of the SUD treatment and recovery fields. As reasonable people committed to the welfare of our clients, we all need to promote and insist upon the ethical treatment of those who need and seek help for their substance use disorders.

REFERENCES 1 Mega Jula, “How Staten Island’s Drug Problem Made It a Target for Poaching Patients”, New York Times, https://www.nytimes.com/2016/08/24/nyregion/how-staten-islands-drugproblem-made-it-a-target-for-poaching-patients.html, accessed January 16, 2017.

2 Boynton Beach addiction treatment center’s CEO, operator arrested, myPalmBeachPost, October 25, 2016 http://www.mypalmbeachpost.com/news/boynton-beach-addictiontreatment-center-ceo-operator-arrested/LlVfJDqWo4GXsyjEDTA4TK/, accessed, 1/27/2017.

3 Justice News, Eight Indicted in Fraud Case That Alleges $50 Million in Bogus Claims for Student Substance Abuse Counseling, September 2, 2015, https://www.justice.gov/opa/ pr/eight-indicted-fraud-case-alleges-50-million-bogus-claims-student-substance-abusecounseling, accessed 1/27/2017.

4 Sobriety for sale: More clinics accused of fraud, King 5, http://www.king5.com/news/local/ investigations/sobriety-for-sale-more-clinics-accused-of-fraud/215246909, accessed 1/27/2017.

5 Los Angeles County District Attorney’s Office, Rehab Center Owner Charged with Sexual Assault, Healthcare Fraud, November 14, 2016, http://da.co.la.ca.us/media/news/rehabcenter-owner-charged-sexual-assault-healthcare-fraud accessed 1/27/2017.

6 Owners of Southland sober living facilities arrested in massive fraud bust, California Department of Insurance Press Release, November 10, 2016, https://www.insurance. ca.gov/0400-news/0100-press-releases/2016/release128-16.cfm, accessed 1/27/2017.

7 Dave Aronberg, Alan Johnson, Justin Chapman, “Report on the Proliferation of Fraud and Abuse In Florida’s Addiction Treatment Industry”, Present of the Palm Beach County Grand Jury, December 8, 2016.

8 Texas Health and Safety Code, Title 2, Subtitle H, Chapter 164, http://www.statutes.legis. state.tx.us/Docs/HS/htm/HS.164.htm accessed 1/27/2107.

9 NAADAC/NCC AP Code of Ethics, http://www.naadac.org/code-of-ethics#i, accessed 1/27/2017.

10 ASAM Public Policy Statement on Principles of Medical Ethics, http://www.asam.org/ docs/default-source/public-policy-statements/1prin-of-med-ethics-10-92. pdf?sfvrsn=0#search=”ethics”, accessed 1/27/2017.

11 National Association of Addiction Treatment Providers (NAATP), https://www.naatp.org/ resources/addiction-treatment-provider-ethics/code-ethics, accessed 1/27/2107.

12 Addiction Treatment Marketers Organization, http://www.recoverymarketers.org/, accessed 1/27/2017.

13 Addiction Treatment Marketing Organization (ATMO) Code of Conduct, Signatories To-Date, http://www.recoverymarketers.org/signatories/, accessed 1/27/2017.

H. Westley Clark, MD, JD, MPH is currently Dean’s Executive Professor of Public Health at Santa Clara University in Santa Clara California. He is formerly the Director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Service, where he led the agency’s national effort to provide effective and accessible treatment to all Americans with addictive disorders. Dr. Clark was also the former chief of the Associated Substance Abuse Programs at the U.S. Department of Veterans Affairs Medical Center in San Francisco, CA and a former associate clinical professor, Department of Psychiatry, University of California at San Francisco (UCSF). Dr. Clark served as a senior program consultant to the Robert Wood Johnson, Substance Abuse Policy Program, a co-investigator on a number of the National Institute on Drug Abuse-funded research grants. He worked for Senator Edward Kennedy as a health counsel on the U.S. Senate Committee of Labor and Human Resources. He has received numerous awards for his contributions to the field of substance abuse treatment, including a 2008 President Rank of Distinguished Executive Award, a 2003 President Rank of Meritorious Executive Award, ASAM’s 2008 John P. McGovern Award, the U.S. Department of Health and Human Services Secretary’s Award for Distinguished Service; and the 2000 Vernelle Fox Award from the California Society of Addiction Medicine. Dr. Clark received a BA in Chemistry from Wayne State University in Detroit, MI; he holds a Medical Degree and a Master’s in Public Health from the University of Michigan, Ann Arbor; and obtained his Juris Doctorate from Harvard University Law School. Dr. Clark received his board certification from the American Board of Psychiatry and Neurology in Psychiatry and ABAM certification in Addiction Medicine. Dr. Clark is licensed to practice medicine in California, Maryland, Massachusetts, and Michigan. He is also a member of the Washington, D.C., Bar.

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Counselor Claims and Complaints: By the Numbers

By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

A

s a program director for an insurance agency specializing in providing professional liability coverage to a range of mental health and behavioral health professionals, I am often asked about the type of claims brought against counselors and what limits of coverage we would recom mend to best protect insureds against claims and complaints. Most professional liability policies have a range of limits to choose from. As insurance agents, we do not recommend limits. We can, however, help counselors decide what limits of coverage to choose by discussing the types of exposures they face, their appetite for risk, and whether they have contractual or verbal requirements to carry certain minimum limits.

It is also help if counselors know the types of claims that are brought, a

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breakdown of payments made by types of claims and complaints that are brought, and other costs the insurance company pays on behalf of insureds.

Here are the major exposures covered under a typical professional liability policy: • Payments resulting from court judgments or out-of-court settlements arising from lawsuits alleging professional malpractice; • Defense Expenses incurred from defending covered claims; • Defense cost reimbursements arising from licensing board and other regulatory hearings; • Costs incurred due to responding to subpoenas, record requests, and depositions;

• Defense cost reimbursement and other expenses arising from suits and penalties sought by regulators due to alleged HIPAA and state privacy law violations; and • Bodily Injury to third parties due to premises liability and other bodily injuries arising from professional services rendered.

To come up with a representative loss analysis, I chose to narrow the total claim history of our agency to annual policies in force over the last ten-year period covering mental health and addiction counselors. Most counselors held a Master’s degree and were licensed/certified counselors.

Life coaches and interns working under supervision were also included.

Social workers, marriage and family therapists, psychologists, psychiatrists, and allied health professionals were not. Most policies were carried by insureds that continuously renewed their policies during this ten year period.

The data contained in the loss analysis was sorted by: • Types of Claims and Complaints • Dollar Costs of Claim Awards and Settlements by types of claims and complaints that have been settled • Defense Expenses by types of claims and complaints that have been settled. Expenses also include those claims that are still under reserve.

• Reserve Amounts for claims and complaints that have not yet been settled (open claims have an expected claim and defense expense cost allocation) • The Total of Claims, Defense Expense, and Reserves

Type of Claims and Complaints There were 997 claims and complaints submitted to our agency during the period studied. Claims are lawsuits (a demand for money) that are usually brought by clients or others on the behalf of clients. Complaints are not a demand for money; they are requests to a state licensing board or regulatory authority for disciplinary action against a counselor when a client feels the counselor has breached ethical standards. A claim or complaint can also be brought by a state or federal regulator from alleged privacy law violations (i.e., HIPAA).

In addition, there were 469 requests to insurance companies for assistance in responding to subpoenas, deposition hearings, and record requests not related to a current claim or complaint against a counselor.

Type of Claim/ Complaint Abandonment

Type of Claim/ No. Complaint 1 Miscellaneous

Improper referral/ child placement Misrepresentation of credentials Alleged false memory Failure to diagnose Wrongful detainment/ hospitalization Violation of Civil Rights Breach of contract

1

Failure to warn

4

1 1

Failure to report abuse Defamation-libel/ slander Improper death of patient/others Premises liability

Type of Claim/ No. Complaint 4 Dual relationship (non sexual) 4 Suicide of patient

No. 12 23

5

Sexual impropriety

28

7

34

2

Bodily injury (not premises)

7

Loss from evaluation Breach of confidentiality Incorrect treatment

2

Violation of legal regulations Counter suit-due to fee collection Reporting abuse to authorities

9

Board complaints

666

9

Total Claims & Complaints: Subpoenarecord requestsdepositions

997

TOTAL:

1466

2

3

7

11

36 118

Dollar Costs of Claim Awards and Settlements Of 331 lawsuits brought, 285 were closed and settled with payments made to plaintiffs. Only 46 lawsuits were closed without payments made to plaintiffs.

Type of Claim/Complaint Reporting of abuse to authorities Loss from evaluations Premises liability Bodily injury (other than premises) Dual relationship (non-sexual) Board complaints Breach of confidentiality Sexual impropriety Suicide of patient Incorrect treatment Improper death of patient/others Total:

Total of Claims/ Settlements $ 6,000 $ 22,803 $ 103,495 $ 118,500 $ 139,999 $ 155,000 $ 305,500 $ 466,250 $ 700,000 $ 891,599 $ 1,245,000 $ 4,154,146

Number of Claims 11 34 7 7 12 2 36 28 23 118 7 285

% of Paid Claims 5% 5% 2% 3% 3% 4% 7% 11% 17% 21% 30% 100%

Defense Expenses Defense expenses include cost to provide lawyers to defend lawsuits brought against insureds and other costs associated with the investigation and/or defense of lawsuits, subpoenas, record requests, and depositions.

With board complaints, most expenses are incurred as reimbursements to insureds for their cost to hire lawyers to help defend them against licensing board complaints.

Type of Claim/Complaint Allege false memory Premises liability Violation of civil rights Failure to report abuse Counter suit Bodily injury-other than premises Violation of legal regulations Failure to diagnose Reporting of abuse to authorities Improper referral/child placement Wrongful detainment/hospitalization Defamation-libel/slander Breach of confidentiality Suicide of patient Dual relationship (non-sexual) Improper death of patient/others Loss from evaluation Subpoena-record requests-depositions Sexual impropriety Board complaints Incorrect treatment Total:

Defense Costs and Expenses $ 688 $ 9,076 $ 12,060 $ 12,618 $ 17,097 $ 19,791 $ 23,746 $ 29,855 $ 76,911 $ 134,892 $ 137,331 $ 195,879 $ 305,777 $ 312,088 $ 341,523 $ 346,694 $ 402,824 $ 599,893 $ 664,793 $1,878,930 $1,947,673 $7,470,138

% of Total Defense Costs 2% (included) (included) (included) (included) (included) (included) (included) (included) 2% 2% 3% 4% 4% 5% 5% 5% 8% 9% 25% 26% 100%

469

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A d va n c e s i n A d d i c t i o n & R e c o v e r y | S P R I N G 2 017

Reserve Amounts This lists the dollar amounts of the anticipated costs (reserves) that the insurance company expects to pay on claims that are still open.

Type of Claim/Complaint Violation of legal regulations Premises liability Suicide of patient Dual relationship (non-sexual) Defamation-libel/slander Failure to diagnose Breach of confidentiality Improper referral/child placement Sexual impropriety Reporting of abuse to authorities Subpoena-record requests-depositions Loss from evaluation Board complaint Incorrect treatment Total:

Reserves $ 3,090 $ 20,000 $ 25,000 $ 26,555 $ 37,891 $ 45,145 $ 59,384 $ 70,108 $ 95,705 $ 176,116 $ 207,344 $ 209,341 $ 537,568 $ 689,400 $2,202,748

% of Total Reserves 3% (included) (included) (Included) 2% 2% 3% 3% 4% 8% 9% 10% 24% 31%

Conclusion The numbers presented in these charts are interesting as they show that: • Reported licensing board complaints are double the number of reported lawsuits with 666 board complaints vs. 331 lawsuits.

• 32% of all reports to insurance companies are a request for assistance with subpoenas, record requests, and depositions.

• The cost to defend lawsuits and complaints are almost twice the settlement amounts.

• Though suits related to the death of patients/others account for 10% of the number of all settled claims, they represent 47% of the total cost of paid claims.

• The total cost to defend claims and complaints ($7,470,138) is higher than the total of all paid claims and reserves ($6,356,894).

• In any given year, 1 of every 100 insureds reports a claim or complaint.

At our agency, when we are asked what liability limits a counselor should carry, we explain that the industry standard limits for Professional Liability are $1,000,000/$3,000,000. By this, we mean that these are the limits most required of counselors by third parties and they are also the most frequently chosen limits. For 99% of insureds that had $1,000,000/3,000,000 limits, the limits they chose were enough to settle their claims without extra cost to them. Of the 285 claims that settled, one insured had claim and expense payments that fell between $1,000,000 and $1,500,000. Four had claim and expense payments that fell between $500,000 and $999,999. A couple more claims may exceed $500,000 once claims still under reserve are settled. The numbers of insureds who came close to or exceeded policy limits of $1,000,000/$3,000,000 represent less than 1% of insureds with claims.

When considering which limits to purchase for Licensing Board Defense coverage, policies usually offer a choice of limits. In our office, insureds can choose limits ranging from $5,000 to $150,000 per hearing. Once again, policy limits for this coverage will reimburse an insured for legal

costs they incur if a client brings a complaint to a state licensing board or regulatory authority. The chart below shows the range of payments made by the insurance companies for this coverage: Licensing Board Defense Payments $ 0 - $ 4,999 $ 5,000 - $24,999 $25,000 - $49,000 $50,000 - $74,999 Over $75,000 Total:

# of Complaints 462 184 12 6 2 666

% of Total Complaints 69% 27% 2% 1% 1%

Most of the insureds in this study purchased $5,000 limits for Defense Reimbursement for Licensing Board coverage. For 69% of insureds who reported a board complaint, their $5,000 limit was enough. But 18% had total defense costs that exceeded the policy limits they purchased.

These 119 insureds paid the difference of what their lawyers charged for services and what their policy paid. If the thought of digging into one’s own pocket to contribute to defense costs for licensing board hearings will cause sleepless nights, then higher limits should be considered.

Take into consideration that over time, claim awards trend higher as do lawyer fees. If you had a professional liability insurance policy for many years without giving much thought to policy limits, make this the year you review your coverage limits with your insurance provider.

Pamela J. Van Cott, CPCU, is Assistant Vice President with the American Professional Agency, Inc. (APA, Inc.), NAADAC’s partner and endorsed professional liability company. Van Cott has 25 years of experience insuring professional liability, with a concentration in the addiction field. APA, Inc. has been a leading writer of professional liability for mental health and other professionals for 40 years. With over 100,000 insureds, APA, Inc. has been endorsed or sponsored by many national and regional mental health associations, including NAADAC. In addition, APA, Inc. has experienced staff to provide risk management consultation services for policyholders.

S P R I N G 2 017 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 37

Earn 1 CE by Taking an Online Multiple Choice Quiz

Earn one Continuing Education hour by taking a multiple choice quiz on this article now at www.naadac.org/magazineces. $15 for NAADAC members and non-members.

1. In Gerard Schmidt’s article, which of the following responsibilities must be “first and foremost” for peer recovery support specialists: a. Understand the boundaries and scope of their expertise. b. Be aware of the limits of their training and capabilities. c. Collaborate with other professionals and recovery support specialists to best meet the needs of the persons they are serving. d. All of the above.

2. In Mita Johnson’s article about enforcing the NAADAC/NCC AP Code of Ethics, which of the following was mentioned as an accurate statement with regards to the importance of enforcing the Code: a. The Code replaces federal, state and/or local laws, as well as certification or licensure rules of the state regulatory body. b. In the case of a potential ethical violation, the NAADAC/NCC AP Ethics Committees will suspend the NAADAC membership and/or NCC AP ­national credential of the person being accused of the ethical violation until the investigation is completed. c. The Code safeguards the integrity of our profession, while first and foremost protects the consumers of our services. d. If the requested state, territory or international licensing authority report concludes that a violation or violations occurred, the Ethics Committees will proceed with an investigation.

3. In Kim Johnson’s article about updating 42 CFR Part 2 to include the protec­ tion of Electronic Health Records (EHRs), which of the following statements is most ­accurate: a. Since so much data is now held “in the cloud” purging electronic records that may be dispersed in multiple places is not possible. b. For consent to release records to individuals and entities other than health care organizations, it is not necessary to identify the individual or entities receiving the records. c. Language regarding how records should be disposed of in the event that a program is closed or merged into another organization is no longer necessary for the security of records. d. The integration of behavioral health into the healthcare system will become the standard and sharing of electronic data on patients to improve care will become an expectation.

4. In his article on predatory patient recruitment, H. Wesley Clark noted that such practices seem to be on the rise as a means of filling beds and profiting from addiction treatment with little regard to effective client care. In addition to NAADAC, which of the following organizations was listed as developing ethical codes that prohibit financial rewards for patient referrals, deceptive or misleading advertising, and other forms of patient exploitation: a. The American Society of Addiction Medicine (ASAM) b. The National Association of Addiction Treatment Providers (NAATP) c. Addiction Treatment Marketing Organization (ATMO) d. a and b only. e. All of the above.

5. In Pamela Van Cott’s article on liability insurance claims, which of the follow­ ing is accurate from the list in her summary of claims and complaints? a. Reported licensing board complaints are double the number of reported lawsuits. b. The majority of all reports to insurance companies are a request for assistance with subpoenas, record requests, and depositions. c. The cost claim settlement amounts are almost twice the cost to defend lawsuits and claims. d. In any given year, 1 of every 25 insureds reports a claim or complaint.

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6. In Tom Durham’s article on the ethical obligations of clinical supervisors, he high­lighted four primary principles of biomedical ethics, included in the 17 principles in the NAADAC/NCC AP Code of Ethics that counselors are rec­ ommended to follow when making ethical decisions. These four primary principles are: a. Autonomy, competence, beneficence, and justice. b. Confidentiality, competence, non-malfeasance, and justice. c. Autonomy, beneficence, non-malfeasance, and justice. d. Competence, autonomy, beneficence and non-malfeasance.

7. In Mita Johnson’s article on the enforcing the new NAADAC/NCC AP Code of Ethics, which of the following are potential disciplinary actions when a NCCcredentialed counselor or NAADAC member is deemed to be in violation of the code following an ethical complaint? a. Written caution, reprimand, suspension, revocation of credential. b. Denial of membership or credential; denial plus assignment. c. A report is sent to the counselor’s state, territory or international licensing authority. d. a and b only. e. All of the above.

8. Gerard Schmidt noted that peer recovery support specialists have a respon­ sibility to help persons in recovery achieve their own personal recovery goals inherent in self-directed discovery by: a. Attending self-help meetings and continuing their own therapy. b. Promoting self-determination, personal responsibility, and empowerment inherent in self-directed recovery. c. Sharing their personal addiction and recovery experiences with clients. d. Going beyond the scope of their services to best meet the needs of clients.

9. In their article on concerns regarding privacy in research, Jack Stein and Maureen Boyle address the fact that privacy and confidentiality laws pose challenges to including behavioral health treatment data in large-scale re­ search projects. Which of the following is not an accurate statement regard­ ing this dilemma? a. Under both current and proposed confidentiality regulation, sharing data with qualified researchers for research purposes without patient consent is allowed. b. Many states have privacy laws to protect data on SUD treatment, but these rules do not prohibit the sharing of data for research. c. Compliance with the privacy laws can be achieved without enormous expense. d. Excluding individuals with SUDs from research can bias results and worsen existing disparities.

10. From Tom Durham’s article on ethical obligations of clinical supervisors, which of the following best depicts the ethical dilemma of multiple relation­ ships for clinicians and/or supervisors? a. When a clinician has a second relationship with a client that is at risk of super ceding the clinical relationship. b. When the supervisor has a second job and thus has limited time to provide adequate supervision. c. When a client is seeing two members of a treatment team at the same facility and is at risk of receiving mixed messages. d. When a clinician has two clinical supervisors and is given conflicting feedback.

■ N A A DAC L E ADE RS HI P NAADAC EXECUTIVE COMMITTEE

NAADAC COMMITTEES

Updated 3/29/2017

North Central

STANDING COMMITTEE CHAIRS

President Gerard J. Schmidt, MA, LPC, MAC

(Represents Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)

Bylaws Committee Chair Ronald A. Chupp, LCSW, LCAC, NCAC II, ICAC II

President Elect Diane Sevening, EdD, LAC Secretary John Lisy, LIDC, OCPS II, LISW-S, LPCC-S Treasurer Mita Johnson, EdD, LPC, LAC, MAC, SAP Immediate Past President Kirk Bowden, PhD, MAC, NCC, LPC National Certification Commission for Addiction Professionals (NCC AP) Chair Jerry A. Jenkins, MEd, MAC Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

James “JJ” Johnson Jr. BS, LADC, ICS Northeast (Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)

William Keithcart, MA, LADC Northwest

Clinical Issues Committee Chair Frances Patterson, PhD, MAC Ethics Committee Chair Mita Johnson, EdD, LPC, MAC, SAP

Malcolm Horn, LCSW, MAC, SAP, NCIP Southeast (Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)

Finance & Audit Committee Chair Mita Johnson, EdD, LPC, LAC, MAC, SAP

Nominations and Elections Chair Kirk Bowden, PhD, MAC, NCC, LPC Personnel Committee Chair Gerard J. Schmidt, MA, LPC, MAC

REGIONAL VICE-PRESIDENTS

Southwest

Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS

Mid-Atlantic

(Represents Arizona, California, Colorado, Hawaii, Nevada, New Mexico and Utah)

AD HOC COMMITTEE CHAIRS

(Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)

Susan Coyer, MAC Mid-Central

Angela Maxwell, MS, CSAPC

Julio Landero, PhD, MAC, MSW, LADC, LASAC Organizational Member Delegate Jim Gamache, MSW, MLADC, IAADC

(Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)

Awards Committee Chair Jamie Durham Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC International Committee Chair Sandra Jones, MS

Diane Sevening, EdD, LAC Mid-South

Leadership Committee Chair Gerard J. Schmidt, MA, LPC, MAC

(Represents Arkansas, Louisiana, Oklahoma and Texas)

Matt Feehery, MBA, LCDC, IAADC

Membership Committee Chair Margaret Smith, EdD, LADC Student Sub-Committee Chair Diane Sevening, EdD, LAC Product Review Committee Chair Jim Gamache, MSW, MLADC, IAADC

Jerry A. Jenkins, MEd, MAC NCC AP Chair Alaska

Tobacco Committee Chair Diane Sevening, EdD, LAC

James “Kansas” Cafferty, LMFT, NCAAC California

PAST PRESIDENTS

NERF Events Fundraising Chair Ed Olson, LCSW, CASAC

(Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)

Professional Practices and Standards Committee Chair Donald P. Osborn, PhD, LCAC

1974-1977 Robert Dorris 1977-1979 Col. Mel Schulstad, CCDC, NCAC II (ret’d) 1979-1981 Jack Hamlin 1981-1982 John Brumbaugh, MA, LSW, CADAC IV, NCAC II 1982-1986 Tom Claunch, CAC 1986-1988 Franklin D. Lisnow, MEd, CAC, MAC 1988-1990 Paul Lubben, NCAC II 1990-1992 Kay Mattingly-Langlois, MA, NCAC II, MAC 1992-1994 Larry Osmonson, CAP, CTRT, NCAC II 1994-1996 Cynthia Moreno NCAC I, CCDC II 1996-1998 Roxanne Kibben, MA, NCAC II 1998-2000 T. Mark Gallagher, NCAC II 2000-2002 Bill B. Burnett, LPC, MAC 2002-2004 Roger A. Curtiss, LAC, NCAC II 2004-2006 Mary Ryan Woods, RNC, LADC, MSHS 2006-2007 Sharon Morgillo Freeman, PhD, APRN-CS, MAC 2007-2010 Patricia M. Greer, BA, LCDC, AAC 2010-2012 Donald P. Osborn, PhD (c), LCAC 2012-2014 Robert C. Richards, MA, NCAC II, CADC III 2014-2016 Kirk Bowden, PhD, MAC, NCC, LPC

Steven Durkee, NCAAC Secretary Kentucky Thaddeus Labhart, MAC, LPC Treasurer Oregon Rose Maire, MAC, LCADC, CCS New Jersey Art Romero, MA, LPCC, LADAC New Mexico Sandra Street, MAC, SAP West Virginia Loretta Tillery, MPA, CPM Public Member Maryland Gerard J. Schmidt, MA, LPC, MAC (ex-officio) West Virginia

NAADAC REGIONAL BOARD REPRESENTATIVES

NORTHEAST NORTH CENTRAL

MID-CENTRAL

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri Therissa Libby, PhD, Minnesota Tiffany Gormley, MS, PLMHP, Nebraska Megan Busch, LAC, LPCC, North Dakota Linda Pratt, LAC, South Dakota

James Golding, MSW, MHS, CAADC, MAC, Illinois Steven Stone, Indiana Steven Durkee, NCAAC, Kentucky Shannon Rozell, MPA, Michigan James Joyner, LICDCCS, ICCS, Ohio Daniel Bizjak, MSW, ICS, CSAC, Wisconsin

Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Gary Blanchard, MA, LADC, Massachusetts Kelly Reardon, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, SAP, New York William Keithcart, MA, LADC, Vermont

NORTHWEST Diane C. Ogilvie, MAEd, Alaska Malcolm Horn, LCSW, MAC, SAP, NCIP, Montana Jennifer Velotta, MNPL, NCAC II, CDP, CPP, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming

SOUTHWEST

MID-ATLANTIC

Carolyn Nessinger, MA, LAC, Arizona Thomas Gorham, MA, CADC II, California Thea Wessel, LPC, LAC, MAC, Colorado Kimberly Landero, MA, Nevada J.J. Azua, LADAC, CPSW, New Mexico Shawn McMillen, Utah

Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia Ron Pritchard, CSAC, CAS, Virginia Patrice Pooler, MA, ADC, West Virginia

SOUTHEAST MID-SOUTH Suzanne Lofton, LCDC, ADC, SAP, Texas

Sam Long IV, NCAC I, Alabama Bobbie Hayes, LMHC, CAP, Florida Ewell Herndon, Georgia Tony Beatty, MA, LCAS, CCS, North Carolina Charles Stinson, MS, South Carolina Lori McCarter, LADAC, QCS, Tennessee

Earn up to 28 CEs!

REGISTRATION NOW OPEN! ■ MAY 24 – 25 IN MAUI

Join NAADAC’s Executive Director, Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, for a two-day training on Romancing the Brain: Conflict Resolution & Recovery. Earn up to 14 CEs!

■ MAY 31 – JUNE 1 IN HONOLULU

Join Darryl S. Inaba, PharmD, CATC V, CADC III, on May 31st for a one-day training on Understanding Marijuana: Pharmacology and New Findings and Kevin McCauley, MD, and Eric Schmidt, MBA, MSW, on June 1st for a one-day training on the Application of Dialectical Behavior Therapy to Substance Use & Mental Health Disorders. Earn 7 CEs per day or 14 CEs for both days!

More information at www.naadac.org/hawaii-trainings NAADAC is excited to announce the following speakers at its 2017 Annual Conference, Elevate Your Practice, in Denver, CO, from September 22–26!

Don’t miss out on learning from these knowledgeable speakers!

Claudia Black

Author | Expert on Adult Children of Alcoholics

Dan Griffin

Author | Expert on Men’s Relationships and Masculinity

Kimberly Johnson

Director, Center for Substance Abuse Treatment, SAMHSA

Stefanie Carnes

President, International Institute for Trauma and Addiction Professionals | Expert on Sex Addiction

CC Nuckols

Author | Expert in Behavioral Medicine & Addictions Treatment

Registration Open! Sponsorships Available! Exhibit Hall 50% Sold Out; Reserve Your Space Now!

www.naadac.org/2017annualconference