Missouri Substance Abuse Professional
Credentialing Board
(573) 751-9211
(573) 522-2073 (FAX)
www.msapcb.com
email: help@msapcb.com
P.O. Box 1250
Jefferson City, MO 65102-1250
Criteria for Certified Substance Abuse Counselor II
(CSAC II)
I.
Criteria for those with an applicable Masters Degree





Applicable Masters Degree
2000 Hours of applicable work experience within the last 10 years
300 Hours of a Supervised Practicum in the IC&RC 12 Core Functions
Signed Competency Rating Form from a Board qualified supervisor
270 Contact Hours of Education to include the following:
 6 Live substance abuse ethics hours (not from online or home study)
 20 Hours obtained in last 12 months
 Pass IC&RC International AODA Examination if not upgrading from CSAC I
II.
Criteria for those with an applicable Bachelors Degree





Applicable Bachelors Degree
4000 Hours of applicable work experience within the last 10 years
300 Hours of a Supervised Practicum in the IC&RC 12 Core Functions
Signed Competency Rating Form from a Board qualified supervisor
270 Contact Hours of Education to include the following:
 6 Live substance abuse ethics hours (not from online or home study)
 20 Hours obtained in last 12 months
 Pass IC&RC International AODA Examination if not upgrading from CSAC I
III.
Criteria for those with an applicable Associates Degree





Applicable Associates Degree
5000 Hours of applicable work experience within the last 10 years
300 Hours of a Supervised Practicum in the IC&RC12 Core Functions
Signed Competency Rating Form from a Board qualified Supervisor
270 Contact Hours of Education to include the following:
 6 Live substance abuse ethics hours (not from online or home study)
 20 Hours obtained in last 12 months
 Pass IC&RC International AODA Examination if not upgrading from CSAC I
criteria continued on next page
Revised 1/10 CSAC II (AODA) Application 1 IV.
Criteria for those with a High School Diploma/GED





High School Diploma/GED
6000 Hours of applicable work experience within the last 10 years
300 Hours of a Supervised Practicum in the IC&RC 12 Core Functions
Signed Competency Rating Form from a Board qualified supervisor
270 Contact Hours of Education to include the following:
 6 Live substance abuse ethics hours (not from online or home study)
 20 Hours obtained in last 12 months
 Pass IC&RC International AODA Examination if not upgrading from CSAC I
APPLICABLE DEGREES
(A degree must be from a college or university found in the US Dept. of Education’s database of accredited
schools. The database can be found at http://ope.ed.gov/accreditation.)
1. Psychology
4. Sociology
7. Nursing
2. Social Work
5. Chemical Dependency
8. Human Services
3. Criminal Justice
6. Counseling
9. Art Therapy
*If your Degree is in an area other than the 9 listed above but you feel it is applicable, please contact the
MSAPCB office at 573-751-9211 to discuss.
Revised 1/10 CSAC II (AODA) Application 2 DEFINITIONS
A. CONTACT HOURS of EDUCATION/TRAINING is defined as workshops, seminars, institutes,
accredited college/university courses, home study or on-line courses as pre-approved by the MSAPCB and inservices. One (1) contact hour of education is equal to sixty (60) minutes of continuous instruction. 15 contact
hours are given for each college credit. Therefore, a college course of three (3) credits is equal to 45 contact
hours.
In order to be considered a valid training experience for the purpose of credentialing, education/trainings must
be related to the knowledge and skill base associated with the 12 counselor core functions: screening, intake,
orientation, assessment, treatment planning, counseling, case management, crisis intervention, client education,
referral, reporting and record keeping, and consultation.
All education taking place outside the applicant's place of employment must be documented through proof of
attendance including original, official transcripts (not issued to the student or copied) from an accredited
college, letters and/or certificates of completion. Supporting documentation in the form of brochures, flyers,
syllabus, course description, etc. may also be required to review content for acceptability.
All education taking place within the applicant's place of employment must be documented by title, date and
length of presentation, as well as the name and title of presenter. The training must be verified by the
employee's supervisor who attests the training took place and the employee was a participant in the entire
training.
B. EMPLOYMENT or WORK EXPERIENCE is defined as supervised work experience in a substance
abuse treatment position with job duties that assist clients in the recovery process by performing the 12 core
functions. Experience as a volunteer, intern and/or payment of a stipend qualifies as work experience if the
same work is performed that a paid employee would perform.
All qualifying employment experience must have been accrued during the ten (10) years immediately prior to
application being made. The maximum hours that can be accrued are one hundred and sixty seven (167) per
month or two thousand (2,000) per year.
Employment experience must be verified by an employment verification form from the agency(s) in which the
applicant has been employed.
C. SUPERVISED PRACTICUM IN THE 12 CORE FUNCTIONS is defined as performance of the 12
counselor core functions while under supervision.
Supervision may be provided by any CSAC II, CASAC, CCJP, CCDP, CCDP-D, RSAP, RSAP-P, LPC,
LCSW, or Licensed Psychologist who has attended the MSAPCB 3 Day Clinical Supervision Training.
The supervision of the 12 core functions may take place within an academic setting and/or within a supervised
work setting. The goal is to receive supervised experience in all of the 12 core functions. Applicants must
complete a minimum of 10 hours performing each of the 12 core functions with a total supervised practicum of
300 hours.
Revised 1/10 CSAC II (AODA) Application 3 Missouri Substance Abuse Professional
Credentialing Board
(573) 751-9211
(573) 522-2073 (FAX)
www.msapcb.com
email: help@msapcb.com
P.O. Box 1250
Jefferson City, MO 65102-1250
Application Instructions:
1. Requirements to receive this credential are subject to change without notice. Please make sure you are
submitting the most recent application packet. If you are unsure, contact the MSAPCB office.
2. The application must be typed or neatly printed.
3. The application must be submitted at least FOUR months prior to the date the applicant desires to take
the exam. An exam schedule is included with this packet.
4. Please keep a copy of all materials submitted for your records.
5. FEES: The total CSAC II Fee for a new applicant taking the IC&RC AODA written exam in Jefferson
City is $350.00 or $400.00 if you are taking the IC&RC AODA computer based exam at a participating
college or university in the state. (This includes the application packet, processing, background
screening, and first time test fees) The total CSAC II Fee for someone upgrading from RASAC I/II is
$275.00 for the IC&RC AODA written exam or $325.00 for the IC&RC AODA computer based exam.
(This includes the application packet, processing, background screening, and first time test fees) The
total CSAC II Fee for someone upgrading from CSAC I is $125.00. (This includes the application
packet, processing, and background screening fees) You may pay by check, money order, or by
providing credit card information on page 7 of this application packet.
6. Please be advised that should your application be reviewed and additional information is requested, you
will have 90 days to provide the requested information. Failure to do so will result in your application
expiring without being approved.
7. All fees are non refundable. If your application is denied or expires, fees will not be refunded.
8. If your application is denied, you may contact the MSAPCB office staff for instructions on how to
appeal the denial of your application.
9. All materials submitted to the MSAPCB office become property of the MSAPCB.
10. The applicant must currently reside and/or be employed in the State of Missouri at least 51% of the time.
The only exception to this is applicants living and working in a state that is not a member of the
International Certification and Reciprocity Consortium.
11. Please remember that it is your responsibility to keep the MSAPCB office informed of any personal
informational changes such as address and phone number changes. If you fail to notify us of changes,
you will be responsible for any material that is mailed to the wrong address and will have to pay a fee to
have the material sent again.
Special Instructions For Those Applicants Upgrading
1. Your application is a continuation from your previous application(s). Therefore, you do not need to
submit duplicate information from previous applications such as transcripts, training certificates sent
with previous applications, etc. However, you must completely fill out the application packet.
Revised 1/10 CSAC II (AODA) Application 4 Missouri Substance Abuse Professional
Credentialing Board
(573) 751-9211
(573) 522-2073 (FAX)
www.msapcb.com
email: help@msapcb.com
P.O. Box 1250
Jefferson City, MO 65102-1250
Useful Information: 1. If at any time during the application process, a question arises about an applicant’s moral character,
reputation for honesty, integrity, or professionalism, the Board may either deny the application at that
time or place the application on hold until an investigation has been done and a decision made regarding
the question brought up.
2. Once your application has been accepted and has final approval, you will receive an entrance letter to
the exam approximately two weeks prior to the exam date. This letter will provide you with the test
information.
3. You will also receive a Candidate Guide prior to the test. This guide provides you sample questions for
the exam. In addition, additional study materials can be purchased. The agencies that sell study guides
are listed on our web site www.msapcb.com under the items for sale link. The exam you will be taking
is called the AODA Exam.
4. The CSAC II credential is a reciprocal credential with other IC&RC member boards that offer this
credential. You can contact the MSAPCB office for more information on reciprocity.
Computer Based Testing Information:
1. Starting with the March 2010 Exam cycle, testing candidates have a choice between taking a written
exam in Jefferson City or a computer based exam in various locations around the state. These locations
include Cape Girardeau, Columbia, Kansas City, Kirksville, Park Hills, Rolla, and Springfield.
2. You will notice under the instructions #5 on page 4 of the application packet that the application fee for
the IC&RC AODA computer based test is higher. This is due to a higher cost charged to the MSAPCB
for the IC&RC AODA computer based test. However, an applicant should be able to offset the higher
cost by taking the exam in a location near them instead of traveling to Jefferson City.
3. An applicant that chooses computer based testing will receive specific instructions from us on how to
complete the exam once the application packet is approved. However, here is basic information to help
an applicant make a decision regarding computer based testing:
A. As mentioned in #1 above, there are 7 computer based testing sites in Missouri. Each of these sites is
a computer testing lab at a university or college.
B. You will have a two-week window to take your testing letter and photo id to the testing lab and
complete the exam.
C. Upon completing the IC&RC AODA computer based exam, you will receive immediate preliminary
results. These will not be official results until you receive a letter and score from the MSAPCB in
the mail approximately 4 weeks after the exam date, however, the preliminary score should be
accurate.
4. On page 34 of this application, the testing dates are listed for the next year. Please note that the dates
listed are for the written exam in Jefferson City. Applicants taking the IC&RC AODA computer based
exam will have the two weeks after the written exam to take the computer based exam. Please also note
that the written exam is only given in March, June, and September while the IC&RC AODA computer
based exam is available in March, June, September, and December.
5. If you have any specific questions or concerns in trying to decide between taking the written or
computer based exam, please feel free to contact us for answers to your questions or concerns.
Revised 1/10 CSAC II (AODA) Application 5 Important Notice To Applicants
According to Missouri Substance Abuse Professional Credentialing Board (MSAPCB) Policies and Procedures,
the following rules apply to those seeking a MSAPCB credential.
1.
2.
No individual currently under any type of court supervision can apply for a MSAPCB credential. Please
wait until you are completely free from court supervision before applying.
The following items disqualify an individual from ever being credentialed with the MSAPCB:
A. Is listed on the Department of Mental Health disqualification registry
B. Is listed on the employee disqualification list of the Dept. Health and Senior Services or Dept. of
Social Services
C. A person who has been convicted of, found guilty to, plead guilty to or nolo contendere to any of
the following crimes. The crimes listed will only disqualify an applicant if the crime was a felony.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.
x.
y.
z.
3.
1st/2nd degree murder
aa. Failure to report abuse and neglect to DSS
Voluntary manslaughter
bb. Any equivalent felony offense
Involuntary manslaughter
cc. Forcible sodomy
1st/2nd degree assault
dd. Deviate sexual assault
Assault while on school property
ee. Sexual abuse
Unlawful endangerment of another
ff.
Abuse of a child
Sexual assault
gg. 1st/2nd degree pharmacy robbery
Tampering with a judicial officer
hh. Arson in the 1st/2nd degree
Kidnapping
ii.
Incest
Felonious restraint
jj.
Causing catastrophe
False imprisonment
kk. 1st degree burglary
Interference with custody
Parental kidnapping
Child abduction
Elder abuse in 1st/2nd degree
Harassment
Stalking
Forcible rape
1st/2nd degree statutory rape
1st/2nd degree assault of a law enforcement officer
1st/2nd degree statutory sodomy
1st/2nd degree child molestation
1st degree sexual misconduct
Endangering the welfare of a child
Robbery in the 1st/2nd degree
Felony count of invasion of privacy
D. Any crime against a minor not listed above
If an individual has applied for and been given an exemption from the Department of Mental Health,
the individual may apply for a MSAPCB credential. Please send in proof of exemption with your
application.
Revised 1/10 CSAC II (AODA) Application 6 APPLICATION
FOR
Certified Substance Abuse Counselor II
(CSAC II)
Appropriate fee must be submitted with application.
MISSOURI SUBSTANCE ABUSE PROFESSIONAL
CREDENTIALING BOARD
P.O. BOX 1250
JEFFERSON CITY, MISSOURI 65102-1250
TELEPHONE: (573) 751-9211
FAX: (573) 522-2073
WEB SITE: www.msapcb.com
EMAIL: help@msapcb.com
Please Mark Credit Card Type:
1. Visa
_____________
2. MC
_____________
3. Discover
_____________
CC Expiration Date:
_____/_______
Credit Card #: __________-______________-______________-____________
Revised 1/10 CSAC II (AODA) Application 7 THIS APPLICATION MUST BE TYPED OR PRINTED NEATLY All Applications Become the Property of MSAPCB Please check if you are: ______ New Applicant ______Upgrade Applicant Please check one: ______ Written Exam ______ Computer Based Exam If wanting to take the Computer Based Exam, please circle the exam location site: Cape Girardeau Columbia Kansas City Kirksville Park Hills Rolla Springfield Applicant’s Name: ___________________________________________________________________________
First
Middle
Last
Sirname
___________________________________________________________________________________________________________
Maiden
Other Names Used
Current Home Address: _____________________________________________________________________________
Street/PO Box
Apt. #
______________________________________________________________________________________________________________________
City
State
Zip
County
Home Telephone: _________/________________
SSN:___________-___________-______________
Work Telephone: _________/_________________
Cell Number: ________/_________________________
E-mail Address: _____________________________________________________________________________
--------------------------------------------------------------------------------------------------------------------------------------OPTIONAL RESEARCH INFORMATION
SEX: ____M ____F
_____AGE ___________________RACE
_____/_____/____________BIRTH DATE
EXPERIENCE IN SUBSTANCE ABUSE TREATMENT FIELD ___0-5 years___6-10 years ___11years & Over
CURRENT SALARY
___$0-$14,999 ___$15,000-$24,999 ___$25,000-$34,999 ___$35,000-$44,999 ___$45,000-$54,999 ___$55,000 & Over
--------------------------------------------------------------------------------------------------------------------------------------Are you currently or have you been credentialed or licensed as a Substance Abuse Professional by any other state or
organization? ______Yes ______No
If yes, which state/organization and when? _____________________________________________________________
What is the type of credential/license held with the other state/organization?
_________________________________________________________________________________________________
Have you ever been ARRESTED and/or CONVICTED of a felony? ____Yes ____No
If yes, please go to the www.msapcb.com website, print off the “Felony Offense Form”, fill out the form and submit
with your application. If you were convicted of a felony listed under 2C on page 6 of this application, you may not
apply for this credential.
Have you ever knowingly been contacted by a Division of Family Services employee regarding a CHILD ABUSE and/or
CHILD NEGLECT incident involving you? ______Yes ______No
If yes, please go to the www.msapcb.com website, print off the “Child Abuse/Neglect Statement”, fill out the form and
submit with your application. In addition, please contact the Division of Family Services at 573-751-2330 and request
a report of the incident to include with this application.
Revised 1/10 CSAC II (AODA) Application 8 Education/Degree Information Name of High School _______________________________________________________________________________
Dates of Attendance from_________________ to _________________Did you graduate? _________________________
Location of High School _____________________________________________________________________________
G.E.D __________ Date _______/_______/________ Where Issued _________________________________________
College and University (undergraduate, graduate, professional)
FROM
NAME AND LOCATION
MO
YR
TO
MO
YR
TOTAL
SEMESTER
HOURS
MAJOR
SUBJECTS
DEGREE AND DATE
RECEIVED AND/OR # OF
CREDIT HOURS
Name ______________________
Location
Name ______________________
Location
Name ______________________
Location
Please have official transcript(s) of any applicable course work to be evaluated for the education
requirement sent directly to the MSAPCB Board office. Student copies or photocopies will not be
accepted.
Revised 1/10 CSAC II (AODA) Application 9 APPLICABLE WORK EXPERIENCE
Describe ONLY your applicable Work Experience below, beginning with your most recent position. If you have held
more than one position with an organization, please list each position separately. Make additional copies of this page if
necessary to document all applicable work experience. Work experience will be prorated if not working full time in an
applicable position. Final determination of the acceptability of work experience shall be at the discretion of the
MSAPCB.
Do you currently work in a CSTAR Program?
1. Where Do You Currently Work?
YES
NO
Name of Employer:
Mailing Address of Employer
Street
City
State
Zip Code
County
Name & Title of Immediate Supervisor:
Your Business Phone: Area Code/Telephone Number
Extension
Your Job Title:
Fax #
Area Code/Telephone Number
Dates of Employment (Month/Day/Year):
From:
To:
Is this a full-time paid position? _________
(2,000 hrs. = 1 year) ________ hrs./wk. paid
2. Where Did You Work Prior To #1 Above
Name of Employer:
Name & Title of Immediate Supervisor:
Mailing Address of Employer
Street
City
Your Job Title:
State
Zip Code
County
Dates of Employment (Month/Day/Year):
From:
To:
Is this a full-time paid position? _________
(2,000 hrs. = 1 year) ________ hrs./wk. paid
3. Where Did You Work Prior To #2 Above?
Name of Employer:
Name & Title of Immediate Supervisor:
Mailing Address of Employer
Street
City
Your Job Title:
State
Zip Code
County
Dates of Employment (Month/Day/Year):
From:
To:
Is this a full-time paid position? _________
(2,000 hrs. = 1 year) ________ hrs./wk. Paid
Revised 1/10 CSAC II (AODA) Application 10 TRAININGS/EDUCATIONAL HOURS
Following are the number of educational hours needed for the CSAC II:
270 Hours Total
 6 Hours of Live substance abuse ethics (not from online or home study)
 20 Hours obtained in last 12 months
In the space below, chronologically list all applicable trainings, workshops, summer institutes,
college coursework, etc. beginning with the most recent training.
Date
Title
Number of
Contact Hours
PLEASE BE SURE TO SUBMIT CERTIFICATES OF ATTENDANCE AND LETTERS OF COMPLETION FOR EACH TRAINING AS LISTED ABOVE. INSERVICE HOURS MUST BE SIGNED BY SUPERVISOR OR TRAINING COORDINATOR IN YOUR AGENCY. Revised 1/10 CSAC II (AODA) Application 11 Additional Space For Chronologically Listed Training
Date
Title
Number of
Contact Hours
PLEASE BE SURE TO SUBMIT CERTIFICATES OF ATTENDANCE AND LETTERS OF COMPLETION FOR EACH TRAINING AS LISTED ABOVE. INSERVICE HOURS MUST BE SIGNED BY SUPERVISOR OR TRAINING COORDINATOR IN YOUR AGENCY. Revised 1/10 CSAC II (AODA) Application 12 MISSOURI SUBSTANCE ABUSE PROFESSIONAL CREDENTIALING BOARD
Code of Ethical Practice and Professional Conduct
Introduction
This document is the foundation for standards which will enable the credentialed professional to
measure the propriety of his or her conduct in dealing with clients, other professionals and other members of the
community. All professionals credentialed by MSAPCB are expected to thoroughly familiarize themselves
with the Code of Ethical Practice and Professional Conduct. The Board is committed to investigate and
sanction those who fail to abide by its standards.
Principles:
Principle 1: Responsibility to Clients
Principle 2: Counseling Relationship
Principle 3: Legal and Moral Standards
Principle 4: Diversity
Principle 5: Professional Competence and Integrity
Principle 6: Compliance with the Law
Principle 7: Cooperation with the Board
Principle 1: Responsibility to Clients
Informed Consent:
Clients have the right to be informed of their rights and responsibilities as they relate to the counseling
process. Professionals assume the responsibility of informing clients, in language appropriate to the client,
how information obtained from assessments will be used in their treatment. Further, clients also have the right
to obtain clear information about their case records; treatment plans, discharge summaries and
recommendations for aftercare. Clients have the right to expect confidentiality in the counseling relationship
and be informed of exceptions to confidentiality. Professionals shall inform clients of their right to refuse any
recommended services and the consequence(s) for their refusal. If a client is unable to exercise their rights,
Professionals will act in the client’s best interest.
Principle 2: Counseling Relationship
General respect and caring:
MSAPCB Professionals provide an appropriate setting for clinical work to protect the client from harm.
Professionals make every effort to respect the dignity and protect the welfare of each client under their care and
shall show respect for each client and colleague by maintaining an objective professional relationship at all
times. Any activity that results in exploitation of clients for personal gain be it sexual, financial or social will be
avoided. Professionals avoid fostering dependent counseling relationships and refrain from imposing their
values on clients.
Revised 1/10 CSAC II (AODA) Application 13 Professionals will remain aware of their own skills and limitations and will not attempt to counsel or advise
clients on matters outside their area of expertise. When it is in the best interest of the client, Professionals will
release or refer the client to another program or professional. The Professional is responsible for making
appropriate arrangements for the continuation of treatment, during interruptions such as vacations and following
termination of the counseling relationship.
Prior to entering into a counseling relationship, the Professional will clearly explain to the client, the
financial arrangements including the use of collection agencies or legal measures for nonpayment.
Dual Relationships:
Professionals shall make every effort to avoid dual relationships with clients that may include, but are
not limited to: familial; social; financial; business; or other types of close personal relationships with clients. It
is the Professionals’ responsibility to refer the client to another professional, if possible, when a dual
relationship exists. When a dual relationship cannot be avoided, Professionals take appropriate professional
precautions to ensure that judgment is not impaired and no exploitation occurs. Professionals do not accept
superiors or subordinates with whom they have administrative, supervisory or evaluative relationships as
clients.
Multiple Clients:
If a Professional provides counseling services to two or more persons who have a relationship (such as
husband and wife, or parents and children), the Professional will identify the individual considered to be the
primary client(s). If it becomes apparent that the Professional may be called upon to perform potentially
conflicting roles, they clarify, adjust, or withdraw from the roles appropriately.
Conflict of Interest:
If a client is receiving services from another mental health professional, the Professional will, with
informed client consent, inform the professional persons already involved and develop clear agreements to
avoid confusion and conflict for the client.
Principle 3: Legal and Moral Standards
Confidentiality:
Professionals consider their clients’ right to privacy to be of paramount importance and avoid illegal
disclosures of confidential information. The Professional adheres to all federal, state, and local laws regarding
confidentiality. Clients are informed of the limitations of confidentiality and identify foreseeable situations in
which confidentiality might be breached. Professionals make every effort to ensure that the privacy and
confidentiality of clients is maintained by subordinates including employees, supervisees, clerical assistants,
and volunteers.
Records:
Professionals maintain records necessary for rendering counseling services to their clients as required
by laws, regulations, or agency or institutional procedures. The Professional is responsible for securing the
safety and confidentiality of any counseling records they create, maintain, transfer, or destroy in whatever forms
the record is produced. This applies to records which are written, taped, computerized, or stored in any other
medium.
Revised 1/10 CSAC II (AODA) Application 14 Professionals acknowledge counseling records are kept for the benefit of clients. Consequently, access
is provided only when requested by competent clients and when it is determined that the records contain
information that is not considered to be misleading or detrimental to the client. When the records involve
multiple clients, access to records is limited to those parts of records that do not include confidential
information related to another client. The Professional discusses information
obtained in clinical, consulting, or observational relationships only in the appropriate settings for
professional purposes that are in the client’s best interest. Every effort is made to avoid undue invasion of
privacy.
Fraud-Related Conduct:
Professionals provide accurate, honest, and unbiased information when reporting professional
evaluations to third parties including courts and health insurance companies. When Professionals provide
advice or comment by whatever means, they take reasonable precautions to ensure that the statements are based
on appropriate professional counseling literature and practice; and the statements are consistent with
MSAPCB’s Code of Ethical Practice and Professional Conduct.
The Professional does not use their official position to seek or receive unjustified personal gains, sexual
favors, unfair advantage, or unearned goods or services. Professionals refrain from charging a client or a third
party payer for a service not performed, or submitting an account or charge for services that is false or
misleading.
Professionals do not publish any advertisement that is false, fraudulent, deceptive or misleading. The
Professional also refrains from engaging in fraud, misrepresentation, deception or concealment of material fact
when applying for or assisting in securing credentialing or credentialing renewal or taking any examination.
Principle 4: Diversity
Nondiscrimination:
The Professional does not condone or engage in discrimination based on age, color, culture, disability,
ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status.
Respecting Differences:
Professionals will actively attempt to understand the diverse cultural backgrounds of the clients with
whom they work. This includes, but is not limited to, learning how the Professional’s cultural/ethnic/racial
identity impacts his/her values and beliefs about the counseling process. The Professional should understand
culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.
Professionals should have a knowledge base of their client’s cultures and be able to demonstrate
competence in the provision of services that are sensitive to clients’ cultures and to differences among people
and cultural groups. The Professional should obtain education about and seek to understand, the nature of
social diversity and oppression with respect to race, ethnicity, national origin, color, sexual orientation, age
marital status, religion, and mental or physical disability.
Revised 1/10 CSAC II (AODA) Application 15 Principle 5: Professional Competence and Integrity
Competence and Self-Knowledge:
Professionals strive to give precedence to their professional responsibility over personal interests and
uphold the dignity and honor of the profession. The Professional shall seek appropriate professional assistance
for their personal problems or conflicts that may impair work performance or clinical judgment. Professionals
have a responsibility to read, understand, and follow the Code of Ethical Practice and Professional Conduct.
Professionals practice only within the boundaries of their competence and avoid practice in specialty areas new
to them until they obtain appropriate education, training, and supervised experience. Professionals accept
responsibility for their continuing education and professional development as part of their commitment to
providing quality care for persons who
seek their services. Professionals take responsibility for identifying their values and beliefs and take measures
to prevent imposing their values on clients. The Professional makes a commitment to continually review their
ethical competence and attend traditional (not online) training session on ethical conduct as determined by
MSAPCB.
Professionals in private practice take reasonable steps to seek out peer supervision to evaluate their
efficacy as counseling professionals.
Sexual Misconduct:
Professionals do not have any type of sexual intimacies with clients and do not counsel persons with
whom they have had a sexual relationship. Professionals do not engage in sexual intimacies with former clients
within a minimum of two years after terminating the counseling relationship. Professionals who engage in such
relationships after two years have the responsibility to document that such relations did not have an exploitative
nature.
Professionals do not engage in sexual harassment. Sexual harassment is defined as sexual solicitation,
physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with
professional activities or roles, and that either is unwelcome, offensive, or creates a hostile workplace
environment. Sexual harassment can consist of a single intense or severe act or multiple persistent or pervasive
acts.
Do no harm:
Professionals refrain from offering or accepting professional services when their physical, mental or
emotional problems may pose a risk to clients or others. They are alert to the signs of impairment, seek
assistance for problems, and, if necessary, limit, suspend, or terminate their professional responsibilities. The
Professional abstains from the non-medical use of any mood altering chemicals while on the job, and will
abstain from all illegal substances at all times. Professionals strive to serve as a responsible role model for
clients, staff and the community.
Revised 1/10 CSAC II (AODA) Application 16 Superior/Subordinate Relationships (Clinical Supervision):
Clinical Supervisors clearly define and maintain ethical, professional, and social relationship
boundaries with their trainees, interns and supervisees. They respect the differential in power that exists
between the supervisor and the trainees, interns or supervisees. The Clinical Supervisor explains to the
trainees, interns and supervisees the potential for the relationship to become exploitative. Clinical Supervisors
do not engage in sexual relationships with trainees, interns or supervisees and do not subject them to sexual
harassment. Clinical Supervisors who supervise the counseling services of others take reasonable measures to
ensure that counseling services provided to clients are professional. Clinical Supervisors do not endorse
trainees, interns or supervisees for credentialing, employment, or completion of an academic or training
program if they believe trainees, interns or supervisees are not qualified for the endorsement. Clinical
Supervisors take reasonable steps to assist students or supervisees who are not qualified for endorsement to
become qualified. Clinical Supervisors clearly state to trainees, interns and supervisees, in advance of training,
the levels of competency expected, appraisal methods and timing of evaluations for both didactic and
experiential components. Trainees, interns and supervisees are provided with periodic performance appraisal
and evaluation feedback throughout the training program. Trainees, interns and supervisees are informed of the
ethical responsibilities and standards of the profession and the trainees, interns and supervisee’s ethical
responsibilities to the profession.
Unprofessional Conduct:
Professionals refrain from participating in inappropriate conduct not befitting their profession. In the
event of an ethics complaint &/or hearing, the Professional’s conduct will be measured against accepted
standards and practices. Professionals have a responsibility to alert their employers to conditions that may be
potentially disruptive or damaging or that may limit their effectiveness.
Inter-Professional Relationships:
Professionals actively participate in local, state, and national associations that foster the development
and improvement of counseling. The Professional shall adhere to a strict policy of respect for the views,
actions, and findings of colleagues and members of other professions and programs. Appropriate practices will
be used when expressing agreement or disagreement in judgment on such matters. The Professional shall not
denigrate other professions nor engage in any false or misleading communications about their own or other
professionals’ abilities, training/experience and ethical conduct. The Professional is respectful of approaches to
counseling that differ from her/his own. Professionals know and take into account the traditions and practices
of other professional groups with which they work. Professionals select competent staff and assign
responsibilities compatible with their skills and experiences. The Professional refuses to participate in an
employer’s practices which are inconsistent with the ethical standards enumerated in this Code.
Principle 6: Compliance with the Law
Unlawful conduct:
All credentialed professionals are expected to comply with all federal, state, and local laws. Anyone who
is convicted of any offense other than a misdemeanor has the obligation to report the conviction to the
MSAPCB. The definition of conviction includes: A plea or verdict of guilty or a conviction following an Alford
Plea, or any other plea which is treated by the court as a plea of guilty and all the proceedings in which the
sentence was deferred or suspended, or the conviction expunged shall be deemed a conviction within the
meaning of this section.
Revised 1/10 CSAC II (AODA) Application 17 Grounds for Discipline:
Permitting, aiding, abetting, assisting, hiring or conspiring with an individual to violate or circumvent
any of the laws relating to licensure or credentialing under any licensing or credentialing act.
Principle 7: Cooperation with the Board
The Professional shall cooperate in any investigation conducted pursuant to this Code and shall not
interfere with an investigation or a disciplinary proceeding or attempt to prevent a disciplinary proceeding or
other legal action form being filed, prosecuted, or completed. Interference attempts may include but are not
limited to: The willful misrepresentation of facts before the disciplining authority or its authorized
representative; the use of threats or harassment against, or an inducement to, any consumer or witness in an
effort to prevent them from providing evidence in a disciplinary proceeding or any other legal action; the use of
threats or harassment against, or an inducement to any person in an effort to prevent or attempt to prevent a
disciplinary proceeding or other legal action from being filed, prosecuted or completed.
Professionals shall report any violation of the Code of Ethical Practice and Professional Conduct.
Failure to report a violation may be grounds for discipline. A Professional who has firsthand knowledge of the
actions of a respondent or complainant shall cooperate with a MSAPCB complaint investigation or disciplinary
proceeding. Failure or an unwillingness to cooperate in a MSAPCB complaint investigation or disciplinary
proceeding shall be grounds for disciplinary action.
Professionals shall not knowingly file a complaint or provide information to the MSAPCB which they
know or should have known is false or misleading. When submitting any information to the Board, the
Professional shall comply with any requirements pertaining to the disclosure of consumer information
established by the federal or state government.
The primary commitment of the Professional is to the health, welfare, and safety of the client. As an
advocate for the client, the Professional must take appropriate action to report instances of incompetent,
unethical, or illegal practice by other credentialed professionals that places the rights or best interests of the
client in jeopardy.
Acknowledgments
The Missouri Substance Abuse Professional Credentialing Board would like to thank the following
agencies/states for their contribution to the preparation of this code:
1. NAADAC
2. Canadian Psychological Association
3. California Association of Addiction Recovery Resources
4. NATTC Curriculum Committee
5. Illinois
6. Hawaii
7. Iowa
8. Connecticut
9. Pennsylvania
10. Arkansas
11. Kansas
12. Arizona
Revised 1/10 CSAC II (AODA) Application 18 Applicant’s Agreement to the Code of Ethical Practice and Professional Conduct
I have read the Code of Ethical Practice and Professional Conduct and agree to abide by this
code:
Signature
Date
AUTHORIZATION AND RELEASE
I hereby certify all of the information given herein is true and complete to the best of my knowledge and
belief. I also authorize any relevant investigations, or the release of personal information to the Missouri
Substance Abuse Professional Credentialing Board, its agents, or contractors pursuant to this
application/renewal procedure. I understand falsification of any portion of this application/renewal will result
in my being denied credentialing, or revocation of same upon discovery.
I further agree to hold the Missouri Substance Abuse Professional Credentialing Board and its Board
Members, officers, agents, staff, peer evaluators and examiners, free from any civil liability for damages or
complaints by reason of any action that is within the scope and arise out of the performance of their duties
which they, or any of them, may take in connection with this application/renewal, the written examination, the
grades with respect to any examination, and/or the failure of the MSAPCB to issue me said credential or
renewal.
This Authorization and Release shall also apply to personal information requested by the Board at any time
following credentialing in connection with any investigation concerning allegations that could lead to
disciplinary action against me.
Signature
Revised 1/10 CSAC II (AODA) Application Date
19 MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES FAMILY CARE SAFETY REGISTRY WORKER REGISTRATION PLEASE TYPE OR PRINT CLEARLY SECTION A: WORKER TYPE (CHECK ONE BOX ONLY) CHILD CARE WORKER ($9.00) PERSONAL CARE WORKER ($9.00) xx VOLUNTARY REGISTRANT ELDER CARE WORKER ($9.00) RECIPIENT OF STATE OR FEDERAL FUNDS ($9.00) FOSTER PARENT (NO FEE)
SECTION B: IDENTIFYING DATA FOR BACKGROUND SCREENING LAST NAME FIRST NAME MIDDLE NAME MAIDEN AND PRIOR NAMES USED
SOCIAL SECURITY NUMBER (ATTACH COPY OF SOCIAL SECURITY CARD) DATE OF BIRTH ‐ ‐ / / GENDER MALE FEMALE TELEPHONE NO. (OPTIONAL) ( ) MAILING ADDRESS STREET ADDRESS OR POST OFFICE BOX CITY STATE ZIP CODE COUNTY HOME ADDRESS (if different than mailing address) STREET ADDRESS CITY STATE ZIP CODE COUNTY SECTION C: CURRENT EMPLOYER INFORMATION (IF APPLICABLE) EMPLOYER NAME CONTACT PERSON PHONE NUMBER ( ) ADDRESS CITY STATE ZIP CODE SECTION D: AUTHORIZATION TO RELEASE BACKGROUND SCREENING INFORMATION The information provided is complete and accurate to the best of my knowledge. I understand it is unlawful to withhold or falsify information required on this form. I grant my permission for the Missouri Department of Health and Senior Services (DHSS) to obtain any and all background information authorized by law to process this request. Futhermore, I authorized the Missouri Department of Health and Senior Services to release the fact that I am a registrant in the Family Care Safety Registry (FCSR) and any related background information to the requestor of the FCSR for employment purposes only, as provided in 210.921, subsection 1 subdivision (1) and (2), RSMo. For purposes of the FCSR, “employment purposes” includes direct employer/employee relationships, prospective employer/employee relationships, and screening and interviewing of persons or facilities by those persons contemplating the placement of an individual in a child care, elder care or personal care setting. I understand that if I dispute the information contained in the FCSR I have the right to appeal the accuracy in the transfer of information to the FCSR within thirty (30) days of receiving the results of the background screening determination. NOTICE: The FCSR may choose to deposit the check enclosed electronically as an ACH debit entry to your designated bank account. I understand that my signature below authorized my Financial Institution to deduct this payment from my account. In the event that DHSS or its subcontractor, is unable to secure funds from your account or you provide insufficient or inaccurate information regarding your account, your obligation to the DHSS will remain unpaid and further collection action may be taken by the DHSS or its subcontractor, including, but not limited to, returned check fees.
SIGNATURE OF APPLICANT (REQUIRED IN INK) DATE / / IMPORTANT 



Individuals are required to register one time only. Contact 1‐866‐422‐6872 (toll‐free) if you have questions on how to complete this form Read back of form for instructions and information on registrant notification and appeal rights Send completed registration form, copy of Social Security card and required fee to: Missouri Department of Health and Senior Services Attn: Fee Receipts P.O. Box 570 Jefferson City, MO 65102 MO 580‐2421 (FP)
Send this form in with your application and with a copy of your social security card. Revised 1/10 CSAC II (AODA) Application 20 Missouri Substance Abuse Professional Credentialing Board
(573) 751-9211
(573) 522-2073 (Fax)
P.O. Box 1250
Jefferson City, MO 65102-1250
COUNSELOR EMPLOYMENT VERIFICATION FORM
An applicant is applying to the MSAPCB for a CSAC II Credential. Please return the completed information
within one week of receipt directly to the Board at the address listed above. This form MUST be notarized and
MUST HAVE JOB DESCRIPTIONS attached for the position listed below. Please make copies of this sheet
and use one sheet for each different job title. Please give a copy of this form to the applicant for their records
and future reference. Please feel free to add any additional or clarifying comments on a separate sheet, as this
information will be confidential.
Employee's Name: __________________________________________________________________________
Supervisor's Name: __________________________________________________________________________
Agency: ___________________________________________________________________________________
Address: ___________________________________________________________________________________
___________________________________________________________________________________________
Telephone: _________________________________________________________________________________
Today’s Date: _______________________________________________________________________________
Applicant’s Job Title: _____________________________________________________________________________________
Please make copies of this sheet and use one sheet for each different job title-attach official job descriptions
Start Date: ______________________________
Only experience within last 10 years is applicable
End Date: ________________________________________
If still in position, use date the form is being filled out
For each of the following 12 core functions, please list the total number of hours of work experience the
applicant completed for each core function while in this position:
Screening:
__________
Treatment Planning: __________
Client Education: __________
Intake:
__________
Counseling:
__________
Referral:
Orientation: __________
Case Management:
__________
Record Keeping: __________
Assessment: __________
Crisis Intervention:
__________
Consultation:
__________
__________
Total # Hours In All Core Functions: _______________________________________________________
Maximum total number of hours allowed by the MSAPCB is 166.67 hours per month or 2,000 hours in 12 months
Superior's Signature: ______________________________________ Title: ______________________________
Signed and sworn to before me this ________ day of ____________________________,__________________
Notary Public: ______________________________________________________________________________
My Commission expires: ____________________________________________________________________
(NOTARY SEAL)
Revised 1/10 CSAC II (AODA) Application 21 Missouri Substance Abuse Professional Credentialing Board
(573) 751-9211
(573) 522-2073 (Fax)
P.O. Box 1250
Jefferson City, MO 65102-1250
SUPERVISED PRACTICUM OF THE 12 CORE FUNCTIONS FORM INSTRUCTIONS: On this form document the number of supervised hours performed in each core function. The applicant
must have completed a total of 300 hours. The applicant must perform a minimum of 10 hours in each function. The
remaining number of hours needed for credentialing can be in any of the functions.
This form must be filled out by a Board qualified supervisor
(Board Qualified Supervisor includes any CSAC II, CASAC, CCJP, CCDP, CCDP-D, RSAP, RSAP-P, LPC, LCSW, or
Licensed Psychologist who has completed the MSAPCB 3 day Clinical Supervision Training. This cannot be an
immediate family member)
FUNCTIONS
Screening - the process by which a client is determined
appropriate and eligible for admission to a particular
program.
NUMBER OF
HOURS
Performed
Client Intake - the process of collecting client
information at the beginning of treatment that is used in
assessment of a client for treatment.
Performed
Client Orientation - individual or group sessions to
familiarize clients with program services, expectations
and goals.
Performed
Client Assessment - the process by which a counselor
evaluates the intake information collected in order to
determine the appropriate services.
Performed
Treatment Planning - defining areas of problems and
needs, establishing long and short term goals, and
developing appropriate strategies for reaching these
goals
Counseling (Individual, Group & Significant Others) a one-to-one counselor/client process for the purpose of
assessing a client's problems and facilitating
appropriate changes.
Performed
Performed
FUNCTIONS
Case Management - activities which bring services,
agencies, resources or people together within a planned
framework of action toward the achievement of
established goals. It may involve liaison activities and
collateral contracts.
Crisis Intervention - those services which respond to
client's needs during acute emotional and/or physical
distress.
NUMBER
OF HOURS
Performed
Performed
Client Education - presenting information with the major
goal of increasing the client's knowledge and recognition
of significant symptoms and patterns of problematic
behavior.
Referral - identifying the needs of the client that cannot
be met by the counselor or agency and assisting the client
to utilize the support systems and community resources
available.
Record Keeping - charting the results of the assessment
and treatment plans; writing reports, progress notes,
discharge summaries and other client-related data.
Performed
Consultation - relating with counselors and other
professionals in regard to client treatment (services) to
assure comprehensive, quality care for the client
Performed
Performed
Performed
Applicant's Name: _______________________________________________________________
Name of Supervisor: _______________________________________
Credential/License Certificate#:________________________________
Title: ____________________________________________________________________________________________________
Agency:_________________________________________________
Clinical Supervision Certificate#:_______________________________
Address:_________________________________________________________________________________________________
Beginning and Ending Dates the Hours Documented Above Were Supervised: _________________________________________
Supervisor's Signature: __________________________________________________
Today’s Date: ____________________
Total Performed Hours Documented Above:______________________________________________________________________
Please return this form directly to MSAPCB, PO Box 1250, Jefferson City, MO 65102-1250. Provide a copy of this form to the
applicant.
Revised 1/10 CSAC II (AODA) Application 22 Missouri Substance Abuse Professional Credentialing Board
(573) 751-9211
(573) 522-2073 (Fax)
P.O. Box 1250
Jefferson City, MO 65102-1250
COMPETENCY RATING FORM
1=Understands; 2=Developing; 3=Competent; 4=Skilled; 5=Master INSTRUCTIONS FOR SUPERVISOR: On this form, a board qualified supervisor should rate the competency of the
applicant in the 10 listed areas using the rating scale 1-5 given above. For help in determining a rating for a particular area use
the competency rating forms found in your clinical supervision manual and/or the TAP 21.
(Board Qualified Supervisor includes any CSAC II, CASAC, CCJP, CCDP, CCDP-D, RSAP, RSAP-P, LPC, LCSW, or
Licensed Psychologist who has completed the MSAPCB 3 day Clinical Supervision Training. This cannot be an
immediate family member)
Rating Practice Dimension 1. Clinical Evaluation – Screening _____ 2. Clinical Evaluation – Assessment _____ 3. Treatment Planning _____ 4. Referral _____ 5. Individual Counseling _____ 6. Group Counseling _____ 7. Family Counseling _____ 8. Client, Family, and Community Education _____ 9. Documentation _____ 10. Professional/Ethical Responsibilities _____ Total Rating Score _____ (Please add the scores together for numbers 1‐10 to get a total rating score) Applicant's Name: _______________________________________________________________
Name of Supervisor: _______________________________________
Credential/License Certificate#:________________________________
Title: ____________________________________________________________________________________________________
Agency:_________________________________________________
Clinical Supervision Certificate#:_______________________________
Address:_________________________________________________________________________________________________
Supervisor's Signature: __________________________________________________
Today’s Date: ____________________
Please return this form directly to MSAPCB, PO Box 1250, Jefferson City, MO 65102-1250. Provide a copy of this form
to the applicant.
Revised 1/10 CSAC II (AODA) Application 23 PLEASE NOTE: Those upgrading from CSAC I are not required to write a CASE PRESENTATION. WRITTEN CASE PRESENTATION BY __________________________ APPLICANT’S NAME (PLEASE TYPE) APPLICANT’S STATEMENT I hereby certify that I have prepared a written case presentation as part of the application process and that it represents an actual/typical case of mine. I, the undersigned, understand that the written case presentation has been done to help me prepare for the IC&RC AODA exam. The case presentation does not need to be submitted to the MSAPCB at this time but could be requested by the MSAPCB at a future date for evaluation and research purposes. SIGNATURE_________________________________________________________________ DATE______________________________________________________________________ SUPERVISOR’S INFORMATION NAME______________________________________________________________________ (PLEASE TYPE) TITLE_______________________________________________________________________ NAME OF AGENCY____________________________________________________________ SIGNATURE_________________________________DATE____________________________ Revised 1/10 CSAC II (AODA) Application 24 DIRECTIONS FOR PREPARING CASE PRESENTATION
PLEASE NOTE: YOUR WRITTEN CASE PRESENTATION MUST BE TYPED
DEMOGRAPHIC INFORMATION ON ACTUAL CLIENT
1.
Use an actual/typical client from your case files, one who has completed treatment or is no longer
obtaining your services. Use a fictitious name for the client. Do not use abbreviations. It is
important to cover all areas required in the global criteria. If a global criteria was not used in the
client presented, reference a case in which the criteria was used.
2.
Write the written case study in the following format: Begin by typing A. Screening as a
subheading, followed by a narrative using the global criteria under the area of screening. Next, go
to B and use the next Core Function Intake as the heading. Follow this format by using all 12 Core
Functions and the Global Criteria under each Core Function.
3.
Sign the completed Counselor Statement on the cover sheet.
4.
Give the completed case presentation to your supervisor for his/her review and signature (on the
cover sheet).
5.
Keep your completed case presentation in case it is requested by the MSAPCB in the future.
6.
Send in the signed cover sheet with your CSAC II Application.
Revised 1/10 CSAC II (AODA) Application 25 CORE FUNCTIONS/GLOBAL CRITERIA
I.
SCREENING: The process by which the client is determined appropriate and eligible for admission to
a particular program.
Global Criteria
1.
Evaluate psychological, social, and physiological signs and symptoms of alcohol and
other drug use and abuse.
2.
Determine the client’s appropriateness for admission or referral.
3.
Determine the client’s eligibility for admission or referral.
4.
Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate need
for additional professional assessment and/or services.
5. Adhere to applicable laws, regulations and agency policies governing alcohol and other drug
abuse service.
Explanation
This function requires that the counselor consider a variety of factors before deciding whether or not to
admit the potential client for treatment.
This is imperative that the counselor use appropriate diagnostic criteria to determine whether the
applicant’s alcohol or other drug use constitutes abuse. All counselors must be able to describe the
criteria they use and demonstrate their competence by presenting specific examples of how the use of
alcohol and other drug has become dysfunctional for a particular client.
The determination of a particular client’s appropriateness for a program required the counselor’s
judgment and skill and is influenced by the program’s environment and modality (i.e., inpatient,
outpatient, residential, pharmacotherapy, detoxification, or day care) Important factors include the
nature of the substance abuse, the physical condition of the client, the psychological functioning of the
client, outside supports/ resources, previous treatment efforts, motivation and philosophy of the
program.
The eligibility criteria are generally determined by the focus, target population and funding requirement
of the counselor’s program or agency. Many of the criteria are easily ascertained. These may include
the client’s age, gender, place of residence, legal status, veteran status, income level and the referral
source. Allusion to following agency policy is a minimally acceptable statement.
If the applicant is found ineligible or inappropriate for this program, the counselor should be able to
suggest an alternative.
Revised 1/10 CSAC II (AODA) Application 26 II.
INTAKE: The administrative and initial assessment procedures for admission to a program.
6.
Complete required documents for admission to the program.
7.
Complete required documents for program eligibility and appropriateness.
8.
Obtain appropriately signed consents when soliciting from or providing information to
outside sources to protect client confidentiality and rights.
Explanation
The intake usually becomes an extension of the screening, when the decision to admit is formally
made and documented. Much of the intake process includes the completion of various forms.
Typically, the client and counselor fill out an admission or intake sheet, document the initial
assessment, complete appropriate release of information, collect financial data, sign consent for
treatment and assign the primary counselor.
III.
ORIENTATION: Describing to the client the following: general nature and goals of the program; rules
governing client conduct and infractions that can lead to disciplinary action or discharge from the
program; in a non-residential program, the hours during which services are available; treatment costs to
be borne by client, if any; and the client’s rights.
9.
Provide an overview to the client by describing program goals and objects for client care.
10.
Provide an overview to the client by describing program rules and client obligations and
rights.
11.
Provide an overview to the client of program operations.
Explanation
The orientation may be provided before, during and/or after the client’s screening and intake. It
can be conducted in an individual, group or family context. Portions of the orientation may
include other personnel for certain specific aspects of the treatment, such as medication.
IV.
ASSESSMENT: The procedures by which a counselor/program identifies and evaluates an individual’s
strengths, weaknesses, problems and needs for the development of a treatment plan.
12.
Gather relevant history from client including but not limited to alcohol and other drug
abuse using appropriate interview techniques.
13.
Identify methods and procedures for obtaining corroborative information from significant
secondary sources regarding client’s alcohol and other drug and psycho-social history.
14.
Identify appropriate assessment tools.
15.
Explain to the client the rationale for the use of assessment techniques in order to facilitate
understanding.
Revised 1/10 CSAC II (AODA) Application 27 16.
Develop a diagnostic evaluation of the client’s substance abuse and any coexisting
conditions based on the results of all assessments in order to provide an integrated
approach to treatment planning based on the client’s strengths, weaknesses, and identified
problems and needs.
Explanation
Although assessment is a continuing process, it is generally emphasized early in treatment. It
usually results from a combination of focused interviews, testing and/or record reviews.
The counselor evaluates major life areas (i.e., physical health, vocation development, social
adaptation, legal involvement and psychological functioning) and assesses the extent to which
alcohol and drug use has interfered with the client’s functioning in each of the areas. The result
of this assessment should suggest the focus of treatment.
V.
TREATMENT PLANNING: Process by which the counselor and the client identify and rank problems
needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment
process and the resources to be utilized.
17.
Explain assessment results to client in an understandable manner.
18.
Identify and rank problems based on individual client needs in the written treatment plan.
19.
Formulate agreed upon immediate and long-term goals using behavioral terms in the
written treatment plan.
20.
Identify the treatment methods and resources to be utilized as appropriate for the
individual client.
Explanation
The treatment contract is based on the assessment and is a product of a negotiation between the
client and the counselor to assure that the plan is tailored to the individual’s needs. The language
of the problem, goal, and strategy statement should be specific, intelligible to the client and
expressed in behavioral terms. The statement of the problem concisely elaborates on a client
need identified previously. The goal statements refer specifically to the identified problem and
may include one objective or a set of objectives ultimately intended to resolve or mitigate the
problem. The goals must be expressed in behavioral terms in order for the counselor and client to
determine progress in treatment. Both immediate and long-term goals should be established.
The plan or strategy is a specific activity that links problem with the goal. It describes the
services, who will perform them, when will be provide, and at what frequency. Treatment
planning is a dynamic process and the contracts must be regularly reviewed and modified as
appropriate.
Revised 1/10 CSAC II (AODA) Application 28 VI.
COUNSELING: (Individual, Group, and Significant Others): The utilization of special skills to assist
families or groups in achieving objectives through exploration of a problem and its ramifications;
examinations of attitudes and feelings; consideration of alternative solutions; and decision-making.
21.
Select the counseling theory(ies) that apply(ies).
22.
Apply technique(s) to assist the client, group, and/or family in exploring problems and
ramifications.
23.
Apply techniques(s) to assist the client, group, and/or family in examining the client’s
behavior, attitudes, and/or feelings if appropriate in the treatment setting.
24.
Individualize counseling in accordance with cultural, gender, and lifestyle differences.
25.
Interact with the client in an appropriate therapeutic manner.
26.
Elicit solutions and decisions from the client.
27.
Implement the treatment plan.
Explanation
Counseling is basically a relationship in which the counselor helps the client mobilize resources
to resolve his or her problem and/or modify attitudes and value. The counselor must be able to
demonstrate a working knowledge of various counseling approaches. These methods may
include Reality Therapy, Transactional Analysis, Strategic Family Therapy, Client-Centered
Therapy, etc. Further, the counselor must be able to explain the rationale for using a specific
approach for the particular client. For example, a behavioral approach might be a specific
approach for the particular client. For example, a behavioral approach might be suggested for
clients who are resistant and manipulative or have difficulty anticipating consequences and
regulation impulses. On the other hand, a cognitive approach may be appropriate for a client
who is depressed, yet insightful and articulate.
Also, the counselor should explain his or her rationale for choosing a counseling approach in an
individual, group or significant other context. Finally, the counselor should be able to explain
when a counseling approach or context changed during treatment.
VII.
CASE MANAGEMENT: Activities which bring services, agencies, resources, or people together
within a planned framework of action toward the achievement of established goals. It may involve
liaison activities and collateral contacts.
28.
Coordinate services for client care.
29.
Explain the rationale of case management activities to the client.
Revised 1/10 CSAC II (AODA) Application 29 Explanation
Case management is the coordination of a multiple services plan. Case management decision
must be explained to the client. By the time many alcohol and other drug abusers enter treatment
they tend to manifest dysfunction in a variety of areas. For example, a heroin addict may have
hepatitis, lack job skills and have a pending criminal charge. In this case, the counselor might
monitor his medical treatment, make a referral to a vocational rehabilitation program and
communicate with representative of the criminal justice system.
The client may also be receiving other treatment service such as family therapy and
pharmacotherapy, within the same agency. These activities must be integrated into the treatment
plan and communication must be maintained with the appropriate personnel.
VIII. CRISIS INTERVENTION: Those services which respond to an alcohol and/or other drug abuser’s
needs during acute emotional and/or physical distress.
30.
Recognize the elements of the client crisis.
31.
Implement an immediate course of action appropriate to the crisis.
32.
Enhance overall treatment by utilizing crisis events.
Explanation
A crisis is a decisive, crucial event in the course of treatment that threatens to compromise or
destroy the rehabilitation effort. These crises may be directly related to alcohol or drug use (i.e.,
overdose or relapse) or indirectly related. The latter might include the death of a significant
other, separation/divorce, arrest, suicidal gestures, and a psychotic episode or outside pressure to
terminate treatment. If no specific crisis is presented in the Written Case, relay on and describe a
past experience with a client. Describe the overall picture-before, during, and after the crisis.
It is imperative that the counselor be able to identify the crisis when they surface, attempt to
mitigate or resolve the immediate problem and use negative events to enhance the treatment
efforts, if possible.
IX.
CLIENT EDUCATION: Provision of information to individuals and groups concerning alcohol and
other drug abuse and the available services and resources.
33.
Present relevant alcohol and other drug use/abuse information to the client through
formal and/or informal processes.
34.
Present information about available alcohol and other drug services and resources.
Revised 1/10 CSAC II (AODA) Application 30 Explanation
Client education is provided in a variety of ways. In certain inpatient and residential programs, for
example, a sequence of formal classes may be conducted using a didactic format with reading
materials and films. On the other hand, an outpatient counselor may provide relevant information
to the client individually or informally.
In addition to alcohol and drug information, client education may include a description of selfhelp groups and other resources that are available to the clients and their families. The applicant
must be competent in providing specific examples of the type of education provided to the client
and the relevance to the case.
X.
REFERRAL: Identifying the needs of a client that cannot be met by the counselor or agency and
assisting the client to utilize the support systems and community resources available.
35.
Identify need(s) and/or problem(s) that the agency and/or counselor cannot meet.
36.
Explain the rationale for the referral to the client.
37.
Match client needs and/or problems to appropriate resources.
38.
Adhere to applicable laws, regulations and agency policies governing procedures related
to the protection of the client’s confidentiality.
39.
Assist the client in utilizing the support systems and community resources available.
Explanation
In order to be competent in this function, the counselor must be familiar with community
resources, both alcohol and drug and others, and should be aware of the limitation of each
service and if the limitation could adversely impact the client. In addition, the counselor must be
able to demonstrate a working knowledge of the referral process, including confidentiality
requirements and outcomes of the referral.
Referral is obviously closely related to case management when integrated into the initial and ongoing treatment plan. It also includes, however, aftercare or discharge planning referrals that
take into account the continuum of care.
XI.
REPORT AND RECORD KEEPING: Charting the results of the assessment and treatment plan,
writing reports, progress notes, discharge summaries and other client-related data.
40.
Prepare reports and relevant records integrating available information to facilitate the
continuum of care.
41.
Chart pertinent ongoing information pertaining to the client.
42.
Utilize relevant information from written documents for client care.
Revised 1/10 CSAC II (AODA) Application 31 Explanation
The report and record keeping function is important. It benefits the counselor by documenting
the client’s progress in achieving his or her goals. It facilitates adequate communication between
co-workers. It assists the counselor’s supervisor in providing timely feedback. It is valuable to
other programs that may provide services to the client at a later date. It can enhance the
accountability of the program to its licensing/funding sources. Ultimately, if performed
properly, it enhances the client’s entire treatment experience. The applicant must provide
personal action in regard to the report and record keeping function.
XII.
CONSULTATION WITH OTHER PROFESSIONALS IN REGARD TO CLIENT
TREATMENT/SERVICES: Relating with in-house staff or outside professionals to assure
comprehensive, quality care for the client.
43.
Recognize issues that are beyond the counselor’s base of knowledge and/or skills.
44.
Consult with appropriate resources to ensure the provision of effective treatment services.
45.
Adhere to applicable laws, regulations and agency policies governing the disclosure of
client-identifying data.
46.
Explain the rationale for the consultation to the client, if appropriate.
Explanation
Consultations are meeting for discussion, decision-making and planning. The most common
consultation is the regular in-house staffing in which client cases are reviewed with other
members of the treatment team. Consultations may also be conducted in individual sessions with
the supervisor, other counselors, psychologists, physicians, probation officer, and other service
providers connected to the client’s case.
©1993, ICRC/AODA, Inc. All rights reserved.
Revised 1/10 CSAC II (AODA) Application 32 DOCUMENTATION OF DISABILITY RELATED NEEDS
If you have a learning disability, psychological disability, physical disability, or other hidden disability which requires an
accommodation in taking the IC&RC International AODA Examination, please: 1) have this section completed by an appropriate
professional (education professional, doctor, psychologist, psychiatrist) to certify your disability/condition requires the requested test
accommodation, and 2) complete the Test Applicant Information section below. If accommodation is not requested in advance, we
cannot guarantee the availability or accommodation on-site.
IF YOU HAVE EXISTING DOCUMENTATION OF HAVING THE SAME OR SIMILAR ACCOMMODATION PROVIDED TO
YOU IN ANOTHER TEST SITUATION, YOU MAY SUBMIT SUCH DOCUMENTATION INSTEAD OF HAVING THIS
PORTION OF THE FORM COMPLETED.
I have known _______________________________________ since ____________________________ in my capacity
(name of test applicant)
(date)
as a ____________________________________________. Today's date: ___________________________________
(professional title)
Signature: _________________________________________
License # (if applicable): _____________________
Nature of applicant’s disability: _____________________________________________________________________
_______________________________________________________________________________________________
The applicant has discussed with me the nature of the test to be administered. It is my opinion that because of this applicant's
disability, he/she should be accommodated by providing the following:
______ Accessible Test Site
______ Braille
______ Large Print
______ Tape
______ Reader as accommodation for visual impairment
______ Scribe/amanuensis as accommodation for visual or motor impairment
______ Reader as accommodation for learning disability
______ Scribe/amanuensis as accommodation for learning disability
______ Sign Language Interpreter
______ Extended testing time
______ Separate testing area
______ Use of computer or other adaptive equipment (specify): ____________________________________________
______ Other (specify): ___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
****************************************************************
TEST APPLICANT INFORMATION SECTION
Applicant's Signature:
Soc. Sec. #:
Address:
Work Phone #:
Home Phone #:
WRITTEN EXAMINATION
TEST DATE:
Mail to: Missouri Substance Abuse Professional Credentialing Board
P.O. Box 1250, Jefferson City, MO 65102-1250
Revised 1/10 CSAC II (AODA) Application 33 EXAM SCHEDULE
Application Due February 4, 2010 May 4, 2010 August 4, 2010 Test Date June 12, 2010 Sept. 11, 2010 Dec. 11, 2010 (Computer Only)
Dates are subject to change without notice.
Written Test is held in Jefferson City, Missouri
Computer Based Testing is available in 7 locations throughout Missouri (See application page 5)
CHECK LIST FOR CSAC II APPLICATION 1. You have submitted either the $350.00 or $400.00 with this application if you are a new applicant, $275.00 or $325.00 if you are upgrading from a RASAC I/II, or $125.00 if you are upgrading from a CSAC I or have provided your credit card information on page 7 of this application packet. 2. You have completely filled out the application. 3. You have indicated on page 8 of the application if you are applying for the written exam or the computer based testing. 4. You have signed the Code of Ethical Practice and Professional Conduct. You only need to submit the signature page with the application. 5. You have filled out the Family Care Safety Registry Worker Registration Form and included the form with your packet. 6. The appropriate training/educational hours were listed and certificates of proof were attached documenting the 270 total hours needed. 7. The appropriate person has completed, signed, and had notarized the Counselor Employment Verification Form and mailed this form directly to the MSAPCB. 8. Official Job Descriptions were attached to the Counselor Employment Verification Form(s). 9. The Supervised Practicum Form was filled out by a Board qualified supervisor and mailed to the MSAPCB. 10. The Competency Rating Form was filled out by a Board qualified supervisor and mailed to the MSAPCB. 11. The appropriate High School/GED or official College transcripts were sent. 12. If necessary, the Case Presentation was completed, signed by you and your supervisor, and the cover sheet was mailed in with the application. Revised 1/10 CSAC II (AODA) Application 34