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ACAD. Associate Counselor Alcohol and Drug. Application

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ACAD Associate Counselor Alcohol and Drug Application 1 HOW TO APPLY ACAD This entry- level, non- reciprocal designation will be granted upon submission of documented proof of eligibility, including supervised
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ACAD Associate Counselor Alcohol and Drug Application 1 HOW TO APPLY ACAD This entry- level, non- reciprocal designation will be granted upon submission of documented proof of eligibility, including supervised training (30 hours), education (30 hours) and experience (300 hours). 1. Read the entire clinical manual thoroughly and obtain appropriate forms from BACB. 2. Complete application forms - type or print clearly. 3. Include all required documents supporting education, training and clinical work experience. Original documents to be sent directly to BACB; and dated within the last five (5) years. 4. Ask three (3) individuals, including your immediate supervisor, who know you professionally to write letters of reference for you. Letters are to be sent directly to the BACB office before your application arrives, and must be dated within the last 5 years. 5 Include your current job description, dated and signed by you and your immediate supervisor. 6 Complete and sign the Release of Information form. This must include the signature of a witness. 7 Sign and date the Code of Ethics. 8 Compare your application package with the ACAD Checklist. 9 Send completed application package, and fee of BD$ Cheques should be made payable to B.A.C.B.; or you may pay online by electronic transfer to BNTB Account No If application is denied, one half (1/2) of the amount will be refunded. 10 When your application is approved by BACB, you will receive written notification and a certificate specifying your designation as ACAD. Please note: you will be expected to complete your education and supervised practice hours in order to apply for the ICADC within five (5) years of obtaining your ACAD. 2 ASSOCIATE COUNSELLOR, ALCOHOL AND OTHER DRUGS (ACAD) KNOWLEDGE AREAS CATEGORY Degree REQUIREMENTS High School Diploma/GED, or higher Work Experience Supervision Education *Refer to TAP21 (www.samhsa.gov) 2,000 hours of direct experience in the field of addiction 100 hours of direct supervision. A minimum of 10 hours must be documented in each of the professional practice dimensions. The remaining 20 hours may be documented in any of the dimensions. 150 hours of training. At least 70 hours must be allocated, as specified, among each of the Professional Practice Dimensions: Clinical evaluation - 10 hours Treatment planning 5 hours Referral 5 hours Service coordination 5 hours Counseling 20 hours Client, family, and community education 5 hours Documentation 5 hours Professional and ethical responsibilities 15 hours At least 74 hours must be allocated, as specified, in the following Transdisciplinary Foundations: Understanding addiction/treatment knowledge 37 hours Application to practice/professional readiness 37 hours At least 6 hours must be allocated in the following topic areas: HIV/AIDS 4 hours Cyber Gambling Drug testing Domestic violence 2 hours Recommendations 3 professional letters of recommendation for certification Code of Ethics Renewal Applicants must attest that they are bound by and will follow the BACB Code of Ethics in their professional practice. 20 CEUs each year 3 Application for Associate Counsellor Alcohol and Other Drugs **READ AND RESPOND TO EVERYTHING** (All responses must be typed, or carefully printed.) Name: Last First Middle Name Tel. (home): ( ) (work): ( ) (cell) ( ) Home Address: 1. Job Title: From: To: Employer Name: Address: Supervisor s Name: Job Duties: Average #Work Hours: per week Total Hours: Estimated Total Hours of Direct Client Contact: 2. Job Title: From: To: Employer Name: Address: Supervisor s Name: Job Duties: Estimated Total Hours of Direct Client Contact: 4 I HAVE REQUESTED THE FOLLOWING INDIVIDUALS TO FORWARD THEIR RECOMMENDATIONS TO THE BACB. (Please list three professionals including your supervisor, who know you professionally, and who can attest to your professional skills.) 1. Name: Tel.# ( ) Address: Employment: 2. Name: Tel.# ( ) Address: Employment: 3. Name: Tel.# ( ) Address: Employment: 4. Name: Tel.# ( ) Address: Employment: 5 FORMAL EDUCATION * Please include photocopies of degrees, diplomas, or certificates original transcripts must be sent directly to bacb Name of School Dates Attended Major Area of Study Year Reached Degree/Diploma/Certificate Earned Name of School Dates Attended Major Area of Study Year Reached Degree/Diploma/Certificate Earned Name of School Dates Attended Major Area of Study Year Reached Degree/Diploma/Certificate Earned Name of School Dates Attended Major Area of Study Year Reached Degree/Diploma/Certificate Earned 6 Bermuda Addictions Certification Board Application for Associate Counselor EDUCATION in Alcohol and/or other Drug Abuse Treatment (30 documented hours) Please attach copies of certificates, letters of completion or attendance, etc. Where possible, include statement of the goals and objectives of the course. Title of Course or Workshop Agency/Institution Offering Training Dates of Attendance Number of Training Hours Title of Course or Workshop Agency/Institution Offering Training Dates of Attendance Number of Training Hours Title of Course or Workshop Agency/Institution Offering Training Dates of Attendance Number of Training Hours Title of Course or Workshop Agency/Institution Offering Training Dates of Attendance Number of Training Hours Title of Course or Workshop Agency/Institution Offering Training Dates of Attendance Number of Training Hours 7 S U P E R V I S I O N 100 hours of direct supervision. A minimum of 10 hours must be documented in each of the professional practice dimensions. PROFESSIONAL PRACTICE DIMENSIONS 1. CLINICAL EVALUATION (Screening and Assessment) Screening the process through which counselor, client and available significant others determine the most appropriate initial course of action, given the client s needs and characteristics and the available resources within the community. 2. TREATMENT PLANNING A collaborative process through which the counselor and client develop treatment outcomes and identify the strategies for achieving them. At a minimum the treatment plan addresses the identified substance use disorders as well as issues related to treatment progress, including relationships with family and a significant others, employment, education, spirituality, health concerns and legal needs. 3. REFERRAL The process facilitating the client s utilization of available support systems and community resources to meet needs identified in clinical evaluation and treatment planning. 4. SERVICE COORDINATION The administrative, clinical and evaluative activities that bring the client treatment services, community agencies and other resources together to focus on issues and needs identified in the treatment plan. Service Coordination includes case management, client advocacy and establishes a framework of action for the client to achieve specified goals. It involves collaboration with the client and significant others, coordinating treatment and referral services, liaison activities, community resources, managed care systems, client advocacy and on-going evaluation of treatment progress and client needs. 5. COUNSELING (Individual/Group and Families/Significant others) A collaborative process that facilitates the client s progress toward mutually determined treatment goals and objectives. Counseling includes methods that are sensitive to individual client characteristics and to the influence of significant others as well as the client s cultural and social context, competence in counseling is built upon an understanding of appreciation of the ability to appropriately use the contributions of various addiction counseling models as they apply to modalities of care for individuals, groups, families, couples and significant others. 6. CLIENT/FAMILY/COMMUNITY EDUCATION The process of providing clients, families, significant others and community groups with information on risks related to psychoactive substance use as well as available prevention, treatment and recovery resources. 7. DOCUMENTATION The recording of the screening and intake process, assessment, treatment plan, clinical reports, clinical progress notes, discharge summaries and other client related data. 8. PROFESSIONAL AND ETHICAL RESPNOSIBILITIES The obligations of an addiction counselor to adhere to accepted ethical and behavioural standards of conduct and continuing professional development. TOTAL HOURS No. of hours Supervisor s Name & Tel # 8 Candidate s Name Supervisor s Name Supervisor s Professional Qualifications Name of Organization and Address: Telephone # ( ) **SUPERVISOR PLEASE NOTE** On the basis of your supervision of this candidate, rate his/her skill using the Likert Scale, in each area below. Circle the appropriate number: Likert Scale: 1 = poor; 3 = average; 5 = exceptional Area of Skill Don t Not Know Applicable Common Sense Self-control Enthusiasm Reliability Personal and professional honesty Empathy Ability to work with others Ethics Knowledge of substance abuse field Understanding of counseling approaches and techniques Appropriateness of counselor/client relationship Communication skills Your general remarks are welcomed, if you wish to write any. I hereby certify that all of the above answers are based on my supervision of this candidate, and are an honest appraisal of the candidate s knowledge and skill. Signature: Date: 9 ACAD Checklist 1. Application information 2. Education forms including all documents, copies of diplomas, certificates or other documents, request for transcript forms. You may be asked to submit original documents for review 3. Employment and supervised practical training forms including signed job description form current, employers/supervisor 4. Supervision form 5. Signed Code of Ethics 6. Signed, witnessed released of information form 7. Fee of $150 (Bermuda Dollars). Cheques should be made payable to B.A.C.B.; or you may pay online by electronic transfer to BNTB Account No If application is denied, one half (1/2) of the amount will be refunded. 8. To be sent directly by referees to BACB office: three professional letters of reference including supervisor s letter 9. Keep copy of ENTIRE application package 10 REQUEST FOR TRANSCRIPTS Date Student ID # Name Surname (Maiden) First Name Middle Initial Date of Birth Contact Numbers Current Mailing Address Parish Postal Code Programme (Social Work, Nursing, Psychology, etc) Year(s) of Attendance Diplomas Received Addresses to which transcript(s) is/are to be sent: (If more than two requests, please continue overleaf or on a separate sheet and attach.) (1) (2) Applicant: Please keep a copy of this form for your personal file. 11 Bermuda Addiction Certification Board 2 Elliott Street, Hamilton, Bermuda. HM09 Tel: Fax: Authorization for Release of Information Name of Applicant: Date of Birth: Address: I, hereby consent to: A) Information and/or reports being obtained B) Information and/or reports being sent C) On-going information be exchanged For the following educational institutions employers or supervisors: Reports: For the following: The information is to used for the following purposes(s): All information obtained will be kept CONFIDENTIAL between (BACB members) and staff and the parties specified above. This release will be effective for (length of time) from the date it is signed. Signature of Applicant Signature of a Witness Date Date A copy of this form is available to the person(s) signing this form. 12 CODE OF ETHICS I, have read the Code of Ethics for Treatment Practitioners, in the BACB Manual which includes the: Introduction Principle One: Principle Two: Principle Three: Principle Four: Principle Five: Principle Six: Principal 7: Service Provision Professional Competence Integrity Confidentiality Ethical Responsibilities to the Work Environment (Primary Employer) Societal Obligations Remuneration I declare that I understand the above principles, and agree to abide by the Code of Ethics for Treatment Practitioners. Signed: Dated: Witness: Dated: 13
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