Application to Practice: Screening, Planning, and Confidentiality
Screening, assessment, and planning
Screening is brief and identifies risk (AUDIT, CAGE, DAST-10, PHQ-9, SBIRT); it does not diagnose. Assessment is comprehensive and biopsychosocial (ASI domains), yielding a diagnosis and treatment plan. Each plan links a problem statement to a client-centered goal, SMART objectives, specific interventions, and review dates. Progress notes must show medical necessity for each service billed.
Counseling skills
Use OARS (open questions, affirmations, reflections, summaries), reflective listening, and respectful, sparing confrontation. Groups have stages and norms; family involvement improves outcomes when consent permits it.
Confidentiality and ethics in practice
42 CFR Part 2 is stricter than HIPAA for federally assisted SUD programs: specific written consent naming the recipient and purpose is required before disclosure, and redisclosure is prohibited without new consent. Exceptions are narrow - medical emergency, mandated child abuse reporting, and a court order meeting Part 2's procedure. A subpoena alone is not sufficient. Know your state's duty-to-warn standard and your scope of practice.
Traps
- Telling a spouse or employer about treatment without valid consent.
- Treating a subpoena as authorization to disclose.
- Diagnosing or using interventions outside your credential.
- Entering dual relationships, or failing to document what you did and why.
Rule of thumb / worked example
"No consent, no disclosure." When a parent calls about an adult client, verify a signed Part 2 consent or decline and explain the exception.