Standards for private organizations

2020 Edition

Opioid Treatment (OTP) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of persons served.

Interpretation

Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
2020 Edition

Currently viewing: OPIOID TREATMENT (OTP)

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Purpose

Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
  • Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or 
  • Most staff who do not meet educational requirements are seeking to obtain them; or 
  • With few exceptions, staff have received required training, including applicable specialized training; or
  • Training curricula are not fully developed or lack depth; or
  • Training documentation is consistently maintained and kept up-to-date with some exceptions; or
  • A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
  • With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
  • Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
  • Specialized services are obtained as required by the standards.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards.  Service quality or program functioning may be compromised; e.g.,
  • A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
  • Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or 
  • Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
  • A significant number of staff have not received required training, including applicable specialized training; or
  • Training documentation is poorly maintained; or
  • A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
  • There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
  • Workloads are excessive, and the integrity of the service may be compromised; or 
  • Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
  • Specialized services are infrequently obtained as required by the standards.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Policy addressing employee health and vaccinations
  • Table of contents of training curricula
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Sample job descriptions from across relevant job categories
  • Training curricula
  • Documentation tracking staff completion of required trainings and/or competencies
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files
  • Verify the employment of, or agreements with, qualified clinicians

 

OTP 2.01

Direct service personnel are qualified by one of the following:
  1. an advanced degree in social work, medicine, psychology, pastoral counseling, marriage and family counseling, mental health or substance use counseling, or psychiatric nursing, and in-service or other training in the treatment of substance use conditions;
  2. a bachelor’s degree in social work or a related human service field with specialized training and experience in the area of substance use treatment;
  3. certification by the designated authority when the state has a mechanism for certifying addiction counselors;
  4. personal experience with drug use recovery and specialized training and demonstrated skills in the area of substance use treatment; or
  5. specific and relevant training in the treatment of substance use and a minimum of two years’ work experience in a substance use treatment service.

 

OTP 2.02

Personnel who administer and dispense opioid treatment medication are:
  1. practitioners licensed and registered under the appropriate federal and state laws; or
  2. supervised by a licensed practitioner.

Interpretation

In some states, practitioners other than licensed physicians are permitted to administer and dispense opioid treatment medications. An “agent” must be a pharmacist, registered nurse, licensed practical nurse, physician assistant, or a healthcare professional authorized by federal and/or state law to administer and dispense opioid treatment medication.

 

OTP 2.03

Supervisors are qualified by:
  1. an advanced degree in a human service field and a minimum of two years’ post-graduate professional experience; 
  2. specialized training and experience in substance use diagnosis and treatment and additional training in supervision; and/or
  3. certification by the designated authority in their state as an approved addiction counseling supervisor.

 

OTP 2.04

A licensed physician with at least one year of experience in addiction medicine or addiction psychiatry, acts as the  medical director responsible for supervising and administering medical services.

 

OTP 2.05

The clinical team, including social work, medical, psychological, and psychiatric professionals with specialized training in the treatment of substance use:
  1. are on staff or available through formal agreement to provide services and support needed to meet the needs of individuals; and 
  2. make level of care, treatment, and termination-of-service decisions with service recipients.

 

OTP 2.06

The medical director and program administrator or sponsor stay current with all applicable federal, state, and local laws and regulations applicable to opioid treatment programs, including those that address technology-based service delivery.

 
Fundamental Practice

OTP 2.07

All personnel and consulting providers are annually screened for tuberculosis and receive a hepatitis B vaccination if they are considered to be at risk for exposure to hepatitis.

 

OTP 2.08

Personnel are trained on, or demonstrate competency in:
  1. the concept of addiction as a disease;
  2. the goals of opioid treatment in regard to other drug use;
  3. the latest information, theories, and techniques in identification, diagnosis, and treatment of alcohol and other drug problems, including the harm reduction model;
  4. relapse prevention;
  5. recognition of co-occurring health and mental health conditions and integrated services available to meet them;
  6. management of drug overdose;
  7. special treatment needs of women;
  8. criminal justice issues, as appropriate;
  9. the benefits and limitations of tests that screen for drug use; and
  10. HIV/AIDS symptoms, risk-reduction and infection control guidelines, testing, and counseling.

 
Fundamental Practice

OTP 2.09

There is at least one person certified in basic first aid and CPR on duty at each program site, at any time the program is in operation.

 

OTP 2.10

The organization minimizes the number of workers assigned to the individual over the course of their contact with the organization by:
  1. assigning a worker at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.

 

OTP 2.11

Employee workloads support the achievement of client outcomes and are regularly reviewed.
Examples: Factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.