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Workforce development includes enriching the work environment through education, staff recognition, and skills training in best practices and supervision, and is recognized as a critical component of the Office of Behavioral Health (OBH). OBH workforce development principles are:
The objective of the Behavioral Health Integration (BHI) Modules is to provide comprehensive and practical information about behavioral health integration that can be applied to healthcare practices. The modules are designed to be interesting, engaging, and to enhance the learners’ ability to understand and maximize BHI into healthcare practice. The content of each module was provided by highly regarded national, regional and local experts. All content is free and available to use for practice instruction and provider support.
The goal in this training module is to examine the value and importance for medically trained primary care team members to address substance use disorders during a patient encounter, and to provide tools to help you move efficiently through this process. We will discuss key points related to assessing and screening, options for treatment and referral, and accommodations for differences between children, adolescents, adults and seniors, as well as any similarities.
Who should complete this module?
The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front & back office staff, and care managers.
Among the top priorities for integrated teams in the primary care setting are the identification, early intervention, and treatment of risky substance use and substance use disorders. Critical to delivering timely, whole-patient care is the ability of each integrated care team member to screen, assess, identify, and treat or refer patients of all ages, cultures, faiths, genders, and socio-economic levels. Any patient can experience complications in their physical health related to their mental health and or substance use, and visa versa. The patient treated by an integrated care team prepared to assess and treat using whole-patient thinking will be better served and will receive a higher level of quality care.
Child and Adolescent
Potential Assessment Tools
SBIRT (Screening, Brief Intervention, and Referral to Treatment) Colorado
Primary care teams play a vital role as the first, and often most frequent opportunity, to identify and treat patients who are misusing opioids. This module examines the value and importance of the medically trained primary care team member in prescribing and monitoring opioid use during a patient encounter and how the primary care team can treat as well as refer these patients. Provided herein are tools to help team members work alongside each other efficiently and effectively in an effort to reduce the risk of patient opioid use disorders. We will discuss key points related to prescribing opioids, assessing patient use and potential abuse of opioids, and programs for monitoring opioid use. Additionally, alternative options for pain management and chronic care accommodations are provided.
Two of the top priorities for integrated teams in the primary care setting are the reduction of opioid prescribing and increased patient utilization monitoring. Preventing patients from starting opioids at all and early identification of use are key to assisting patients in avoiding opioid use disorders. It is critical that integrated care team members are vigilant in working with the whole patient to screen, assess, identify, and treat or refer patients of all ages, cultures, faiths, genders, and socio-economic levels. Any patient can experience complications in their physical health related to their mental health and or substance use, and visa versa. The patient treated by an integrated care team that is prepared to assess and treat using whole patient thinking will be better served and will receive a higher level of quality care.
In this third module on substance use disorders, we dive deeper into the realities of incorporating screening, intervening, and referring patients experiencing them. SBIRT is about helping patients understand where they are with substance use, planting thoughts of change, and providing small interventions that may lead to change over time. We want to ensure our integrating primary care physical and behavioral health care providers have the most current and relevant information to assist them in their work to assess, intervene, and refer patients who are exhibiting risky behavior or substance use disorders. The key points related to incorporating SBIRT in your practice, by the entire patient care team, are discussed. Every member has a role in this powerful and effective approach to early identification and treatment of substance use disorders.
One of the top priorities for integrated teams in the primary care setting is to include all integrated team members in the assessment for, intervention of, and referral for treatment related to risky substance use and substance use disorders.
Prevention and early identification are central to assisting patients in avoiding long-term and life-affecting addiction. SBIRT protocols can be an effective tool when implemented correctly by your entire team. It is critical that integrated team members are vigilant in working with the whole patient to screen, assess, identify, and treat or refer patients of all ages, cultures, faiths, genders, and socio-economic levels.
Toolkits for Impelmentation
What is my role as a clinician in issues related to the role of psychotropic medications in the treatment and care of youth?
It is your responsibility as the clinician to ensure children and youth in out-of-home care receive appropriate treatment and medication by following the most current Psychotropic Medication Guidelines for Children and Adolescents in Colorado’s Child Welfare System publication. Youth treated with psychotropic medications must be followed to ensure that treatment is not prescribed for inappropriate reasons, is implemented correctly, and is adjusted as necessary throughout placement.
The information in this module is valuable for clinicians, practice staff, behavioral health workers, foster care providers, patient advocates, front & back office staff, nurses, care managers, and school representatives.
Colorado State Guidelines for Psychotropic Medications
Nationally, there is a growing awareness of how many youths in foster care are being prescribed multiple psychiatric medications. Research data suggests that about half of youth who enter the foster system have emotional and mental health needs and may benefit from specialized mental health treatment. While higher needs would explain a disproportionally higher rate of psychotropic medications among foster youth than the general population, concerns remain about whether there may sometimes be an overreliance on psychotropic medications to solve the complex problems these youth face.
Why is this important?
The overall purpose of treatment with psychotropic medication is to reduce unwanted mental health symptoms and to restore meaningful quality of life for youth. Medication should never be used as a punishment; as a condition of placement; as a means to restrain a youth, except in emergency situations; or for the convenience of caregivers. Whenever possible, the youth and their caregivers should have a voice in their treatment, and they should clearly understand why a medication is being given. Above all else, medication prescribing should keep youth safety in mind, with constant vigilance for short-term and long-term adverse effects.
The State released guidelines in the 2017 Colorado Guidelines for Psychotropic Medication Use for Children and Adolescents. This work was led by the Colorado Department of Human Services and the Colorado Department of Health Care Policy and Financing. This document is an essential tool to help providers and caregivers connect foster kids to the right care at the right time to improve their quality of life and promote a healthy future.
What are the unique needs of our aging patients? How can we best adapt our team approach and care delivery to meet their unique needs?
The goal of this training module is to ensure integrated primary care teams have the most current and relevant information to develop the foundational relationships needed to deliver care to their senior patients. It is from these relationships that care teams will be best positioned to assess, determine appropriate care plans, and deliver care to their senior patients. Seniors need and want to be heard. It is critical that providers listen with the head and heart – to hear both what is said and what isn’t. Every team member has a role in this powerful opportunity to meet the unique needs of our senior patients.
One of the top priorities for integrated teams in the primary care setting is to include all integrated team members in assessing, determining treatment, and delivering care specifically tailored to meet the needs of our seniors. Working with people in the later years of life is unlike treating a patient’s illness or disorder. Seniors are living a stage of life that demands careful and tailored care. Each person, as we will all experience, has unique wants and needs that must be balanced through consideration of their individual lifestyle (e.g., physical and mental wellness, safe and healthy nutrition, physical strength and mobility, and access to a social network). Seniors ask for respect, thorough and thoughtful care planning, and rely on the care team to ensure integrated health teaming.
View Module Presentations
Tools for Those Caring for Aging Parents
What our aging patients are looking for:
What is the role of integrated care team members as they work together to assess, identify and provide care to patients who are experiencing the ongoing or immediate impact of psychologic trauma?
Our goal in this training module is to examine the value and importance, for both the medical and behavioral health primary care team members, to consider the potential role psychologic trauma may have on a patient’s health and corresponding care plan.
The information in this module is valuable for all integrated team members including clinicians, nurses, behavioral health, medical assistants, front & back office, and care managers.
One of the emerging priorities for integrated teams in the primary care setting is the consideration and identification of the role psychological trauma may play in a patient’s health. This is becoming increasingly important in the treatment of patients as whole people. It is critical to delivering timely and effective care that each integrated care team member is prepared to assess, identify, and treat or refer patients who are currently or have in the past, experienced trauma which is impacting their overall health. Any patient can experience complications in their physical health related to psychologic trauma. The patient treated with integrated care is more likely to have stronger outcomes.
Research articles and tools are provided below to conveniently connect you and your team to current, well-respected information specific to trauma. We will discuss key points related to understanding trauma and how it may be impacting your patients. We provide information about the key role traumatic responses can play as they hamper treatment of what may appear to be unrelated issues.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013.
Blackman, J. S. (2016). Diagnostic and Statistical Manual of Mental Disorders , by American Psychiatric Association. Washington, DC: Author, 20. Psychoanalytic Psychology, 33(4), 651-663.
Foa, E. B., McLean, C. P., Zang, Y., Zhong, J., Rauch, S., Porter, K., … & Kauffman, B. Y. (2016). Psychometric properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM–5 (PSSI–5). Psychological Assessment, 28(10), 1159.
What role does the primary care team play in identifying and treating behavioral health issues for children and families?
The focus of this module is on the primary care team as it addresses behavioral health issues with young children and their families. Through the 4 domains of Screening Processes, Prevention and Health Promotion, Consultation or Intervention, and Care Coordination and Systems Navigation, primary care providers have an amazing opportunity to support parents by validating their concerns, and caring for children when development is happening more rapidly. The team benefit of having an integrated practice is discussed where team members can support each other in a full and comprehensive way.
Primary Care physicians play a critical role as a port of entry for the health and well-being of young children and their families. They often serve in the positions of front line behavioral health specialists, because families trust their primary care providers and primary care providers are often the very first ones to hear when things aren’t going well.
The primary care team can identify when there are concerns or delays or challenges for a young child, and then support parents by taking their concerns seriously and help them find the best solutions. This pro-active approach to behavioral health can happen at a time in a child’s life where it is more cost-effective to intervene early. Development is happening more rapidly for the young child, serious concerns can be redirected, and new skills and capacities can be supported to be developed for the child.
Sattler, A. F., Leffler, J. M., Harrison, N. L., Bieber, E. D., Kosmach, J. J., Sim, L. A., & Whiteside, S. P. H. (2018, May 17). The Quality of Assessments for Childhood Psychopathology Within a Regional Medical Center. Psychological Services.
This module describes the relationship between obesity and depression and recommended screening and treatment recommendations for both conditions.
Both depression and obesity are widespread conditions with major personal and public health implications. Major depression is a commonly occurring, seriously impairing, and often recurrent mental disorder. The World Health Organization ranks major depressive disorder (MDD) as the 4th leading cause of disability worldwide. MDD is estimated to affect around 16 million Americans, and in the U.S. workforce, the prevalence of MDD has been estimated at 7.6%. The total economic burden of MDD is now estimated to be $210.5 billion per year. (Source: Mental Health Topics- Depression:Quantifying the Cost of Depression)
Data from the National Health and Nutrition Examination Surveys (NHANES) 2005-2010 showed:
(Source: CDC.gov NCHS Databriefs)
What is the association between obesity and depression?
Recent evidence shows that being overweight or obese are risk factors for depression. In fact, the prevalence of depression increases as BMI increases from less than 25 kg/m2 to greater than 40 kg/m2. And a common question is: which comes first and is this a “chicken or egg phenomenon”? Research has shown there does not seem to be one answer, and in fact, these two conditions tend to make each other worse. Following is a review of recent research into this question:
Obesity causes depression
Research has shown that obesity is related to poor self-image, low self-esteem, and social isolation, which are also known to cause depression. In addition, both childhood sexual abuse and physical abuse are associated with doubling the odds of both obesity and depression.
Depression causes obesity
A study of adolescents in Cincinnati found that teenagers with symptoms of depression were more likely to become obese within the following year. People with depression at baseline were 1.8 times more likely to have obesity or weight gain at follow-up, and in a meta-analysis of 23 longitudinal studies of people with depression, the majority showed weight gain over time, and very few showed weight loss. Additionally, people experiencing depression are more likely to overeat or make poor food choices, avoid exercise, and become more sedentary – all of which can lead to weight gain.
(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568994/ )
Another complicating factor is that common medications to treat depression can cause weight gain.
The most common medications used to treat depression which may cause weight gain include (please note some of these medications are older-generation and may not be currently prescribed):
Please note that Article #2, in the Literature review section, goes into further details regarding medications that promote weight gain.
Screening for obesity and depression
Body Mass Index (BMI) obtained on all patients.
Women with a history of childhood physical or sexual abuse are at higher risk of obesity and depression and can be screened using the PHQ-9 or the Adverse Childhood Events questionnaire.
Additional risk factors that should trigger screening for depression include sleep apnea, chronic medical conditions, chronic pain syndromes, and binge eating.
(Source: Best Practices for Screening and Interventions for Obesity and DepressionCO.pdf)
Treatment options for both obesity and depression
Regardless of the potential causes of obesity and depression, they both have common risk factors and treatment options. Following are intervention recommendations from the Colorado Department of Public Health and Environment.
Design an office workflow for depression diagnosis, treatment and follow-up (also see the SIM Integrated Workflow module), including the integration of your practice’s behavioral health professional.
Assign specific responsibilities to different members of the team.
Help individuals change behaviors using empathy as the core of effective conversations.
Use brief supportive counseling interactions (also see the Practice Transformation Patient Self-Management Support module).
Consider co-consults or “warm hand-offs” with your practice’s behavioral health professional or refer for mental health treatment.
The following two short videos demonstrate an integrated team approach to addressing depression and obesity. In the first video, the medical provider and the patient work collaboratively to determine the patient’s main concerns, followed by a warm handoff to the behavioral health provider. In the second video, the behavioral health provider and the patient work together to develop a treatment and follow-up plan. Please watch how both providers manage the dual needs for the patient in this visit.
Drs. Bleacher and Reed model how their communication can quickly and effectively assist the patient’s concerns.
Key Points Review:
As described previously in this module, there appears to be a strong correlation between obesity and depression. This research article discusses the metabolic abnormalities stemming from central obesity that lead to metabolic disease and may also be responsible for the increased incidence of depression in obesity. This review article focuses specifically on the impact of adiposity, diet and associated metabolic signals in the development of depression and negative emotional states.
Mood, Food, and Adiposity:
Emotions such as joy, frustration, and fear can profoundly affect appetite and food choice. External or psychological stressors can have divergent effects on feeding behavior such that some individuals increase food intake in response to a stressful experience while others eat less. For example, a recent study found that women reporting higher chronic stress with low cortisol reactivity to an acute social stress test consumed more calories from chocolate cake and fewer vegetables than those experiencing low chronic stress. Likewise, a similar positive correlation between social stress and choice of palatable, energy-rich foods over fruits and vegetables is observed in children. Mood states such as anxiety and depression can also affect food choice and energy metabolism. Individuals experiencing depressed mood show preference for and consumption of palatable “comfort foods” and self-report use of these foods as means to alleviate negative feelings. While short-term consumption of palatable foods can provide relief from negative emotions and mood states, chronic consumption of calorically-rich foods and subsequent increases in adiposity may promote vulnerability to depression and anxiety.
Evidence suggests that diets high in saturated fat and relatively low in polyunsaturated and monounsaturated fatty acids contribute to the pathogenesis of both mood and metabolic disorders during obesity. The consumption of foods rich in saturated and/or trans-fat, like the Western diet, is associated with an increased incidence of depression whereas diets containing mostly unsaturated fats, such as the Mediterranean diet, appear to reduce the odds of depression.
Importantly, central adiposity is a better predictor of depression and anxiety risk than body weight or body mass index (BMI). A considerable amount of data shows that diets rich in saturated fatty acids are associated with increases in overall adiposity and bias fat accumulation in abdominal stores. As compared to individuals on a Mediterranean diet, those consuming a diet high in saturated fat have increased weight gain, a greater volume of visceral adipose tissue, larger waist circumference, and more cardiovascular disease.
Metabolic Signals and Emotional States:
Figure 1 of the article depicts the metabolic signals and disturbances linking obesity and abdominal adiposity with depression. Several endocrine and metabolic abnormalities have been linked to depressed mood or depressive-like behavior including hypercortisolemia, insulin and leptin resistance and metabolic inflammatory signals. Some of these links include:
Article 2: How to Manage Depression in Overweight or Obese Patients
This article describes the causes and treatment of both depression and overweight and obesity. Treatment options include:
In summary, several treatment options have been shown to improve both depressive symptoms and weight management.
Article 3: Effects of a Gender-Tailored eHealth Weight Loss Program on the Depressive Symptoms of Overweight and Obese Men: Pre-Post Study
The objective of this study was to examine the effect of a gender-tailored electronic health (eHealth) program on the depressive symptoms of a community sample of overweight and obese men with or without depression. This study was conducted in Australia where all men were part of the SHED-IT program, a self-administered eHealth program that included no personalized intervention components. The program consisted of 1) the SHED-IT Weight Loss Handbook and Weight Loss Log Book for Men, 2) the SHED-IT Weight Loss DVD for Men, 3) self-monitoring tools (i.e., tape measure, pedometer), and 4) weekly motivational text messages (standardized). During the program, men were advised to self-monitor their physical activity and diet using the freely available CalorieKing Australia website or MyFitnessPal app to create a 2000 kilojoule energy deficit (approximately 500 kcal) on most days. After receiving the resource pack and instruction sheet, participants were not provided with additional support during the intervention period.
Depressive symptoms were measured using the 8-item Patient Health Questionnaire (PHQ-8). Results of this study showed that men with depression (PHQ-8 score >10) reported a substantial decrease in depressive symptoms during the study, with 72% of these men no longer meeting the criterion for depression on post-test. Overall, these changes represented a mean decrease in depressive symptoms of 1.8 units. The overall intervention effect on weight was -4.7 kg, which did not vary significantly by depression status. The results of this study corroborate a recent review that determined that lifestyle modification can effectively reduce depressive symptoms. http://europepmc.org/abstract/MED/21343903
Men account for the vast majority of suicide deaths in the U.S. each year, and 40% of these men visited their primary care practice within 30 days of their death (advancingsp.org). Additionally, men often present with different symptoms of depression than women. This module covers depression symptoms more commonly found in men, screening and treatment options, and resources available that specifically address depression in men.
The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front and back office staff, and care managers.
Depression is historically considered a woman’s disease, partly because of the perception of a lower incidence of depression among men compared to women. The prevalence of major depression is higher in women than men (5.5% and 3.2%, respectively) representing a 1.7-fold greater incidence (likelihood of diagnosis) in women. However, the lower prevalence of depression among men might be the result of men’s tendency to deny illness, self-monitor and self-treat symptoms, and avoid professional health care providers and services as a means to enact and preserve their masculinity. It is important for healthcare providers to be aware that even though men are not diagnosed with depression as often as women, this does not mean that men are not struggling with depression and need to be screened and treated accordingly.
Recognizing depression in men is important due to the fact that working aged men (25-54 years old) account for the largest number of suicide deaths in the U.S. In fact, males represent 78% of all U.S. suicides. Yet men generally are less likely to seek help and support from family, friends, or healthcare professionals.
Signs and Symptoms of Depression in Men
More “traditional” depressive symptoms, such as crying and sadness, are often not associated with societal ideals of masculinity, and men don’t generally present with these symptoms. As such, depression in men is often under-diagnosed and under-treated. Depression in men often manifests itself as irritability, anger, hostile, aggressive, abusive behavior, risk-taking, substance abuse, and escaping behavior (e.g., over-involvement in work). Additional symptoms include (and many are similar to depressive symptoms for women):
Causes of Depression in Men
There is little evidence to support the idea that there are large differences between men and women when it comes to triggers for depression. Current research indicates that depression is caused by a combination of risk factors, including:
Treatment options for men are similar to those for women, including the use of antidepressant medication, psychotherapy, or a combination of both. Several pharmacologic agents have evidence of efficacy, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, tricyclics, and monoamine oxidase inhibitors. However, it is important to keep in mind that some antidepressant medications, particularly SSRIs, may lead to sexual dysfunction.
Several forms of short-term, time-limited psychotherapy, including psychodynamic psychotherapy, cognitive behavioral therapy, and interpersonal therapy, have been demonstrated to be effective for treating depression. All-male group therapy has been found to provide men with a safe environment to discover and express intense and vulnerable emotions associated with their depression and allow them to connect through a shared experience. It is important to consider the patient’s preference for treatment, as studies have found that this can significantly influence outcomes.
(Source: Real Men. Real Depression.; Man Therapy; Can Fam Physician 2011;57:153-5.)
There are several resources that are specific to issues related to men and depression. These include:
Man Therapy – This website was created as a comprehensive public education campaign and resource about men’s mental health. Project materials include information, education, and resources for primary care physicians and practices. The website founders have also published two white papers (below) on their work on men and depression and prescription pads to engage patients with depression awareness and management.
See also the Colorado Department of Public Health and Environment's Suicide Prevention Toolkit.
United States Movember Foundation – This website provides instructional tools for preparing to have a tough conversation. It also provides the following handouts: How to be a Good Friend; How to be a Good Colleague; How to Reach Out and; How to Keep an Eye Out.
Men account for the vast majority of suicide deaths each year, and firearms are used in half of these deaths in Colorado. As such, addressing how to safeguard firearms is an important issue. The following Safeguard brochure from the Colorado Department of Public Health and Environment is a guide for safeguarding your home when a family member is at risk for suicide.
The following video, Common Mental Health Challenges for Men - LockerRoomDoctor.com is from Mike Evans, a Canadian family physician. This short and humorous video describes common depression symptoms and treatment recommendations for men.
The objective of this study was to explore whether sex disparities in depression rates disappear when alternative symptoms are considered in the place of, or in addition to, more conventional depression symptoms. The researchers used data from the National Comorbidity Survey Replication, which is a nationally represented mental health survey. Two new scales were developed to evaluate sex differences in symptom endorsement for depression. Results showed that men were significantly more likely to report symptoms of anger attacks/aggression, irritability, substance abuse, and risk-taking behaviors over symptoms such as withdrawal from friends, sleep problems, and feelings of complaintiveness. The researchers concluded that relying only on men’s disclosure of traditional symptoms could lead to an underdiagnosis of depression in men and that clinicians should consider other clues when assessing depression in men.
Article 2: Canadian Men's Perspectives of Depression: Awareness and Intention to Seek Help
This study, conducted by Canadian researchers, looked Canadian men’s perspectives regarding awareness of depression and likelihood of seeking help for depression when solicited. A total of 452 English-speaking Canadian adult males completed the survey and almost ¼ (23.1%) reported a history of depression; and 79% indicated that they perceived depression to have a fairly significant or very significant impact on Canadian men, suggesting that most men regard depression to be a serious health issue. Only 59% felt fairly or very well informed about depression, revealing that knowledge about depression itself is lacking among a considerable proportion of Canadian men. However, regarding discussion of depression with others, the majority of respondents indicated they would be somewhat or extremely likely to talk to their partner or spouse (64%); family member (60%); or close friend (60%). Interestingly, the majority (83%) indicated they probably or definitely would seek professional help for depression. It is notable the discordance between the finding that a majority of men cite intentions to seek help should they need it and reports of low mental health service utilization among men. The implications of these findings are that targeted public health initiatives are required to improve men’s understanding of depression, which may help translate men’s strong intentions to seek help into concrete action should the need arise.
Article 3: Advancing Suicide Prevention: Special Issue on Men at Risk
This special issue focuses on advancing suicide prevention for at-risk men. The publication covers many important issues and starting on page 24, focuses on the role of the primary care setting. Forty percent of people of all age groups who complete suicide have made contact with their primary care provider within a month of their death. This staggering statistic highlights the need for primary care practices to effectively screen and treat patients with depression and suicidal ideations. Primary care physicians and practice staff are in a unique position to recognize symptoms of depression, addictive disorders, and suicide. A collaborative team approach with co-location of a behavioral health professional, such as what is recommended for SIM practices, is the best way to identify and treat these patients. Please refer to the SIM Integrated Workflow e-Learning module for information on effective ways to organize office workflows to maximize the integration of behavioral health into your practice.
Putting it Into Practice
Men tend to underreport depression and they often present with symptoms related to irritability, anger, aggression, and substance abuse. This activity asks you and your practice team to evaluate your screening and treatment practices for men and depression. Please complete this worksheet as part of your quality improvement team activities.
OBH has the authority for setting competency training standards for the addiction counselor workforce. Certification and licensure in Colorado requires a combination of specialized training and clinically supervised work experience in the addiction field. Additionally, OBH periodically reviews the addiction counselor certification and licensure rules and revises them when needed to reflect current research, treatment methods and competencies needed for the workforce. OBH and the Colorado Department of Regulatory Agencies (DORA) work together to provide the path to certification and licensure for aspiring addiction counselors in Colorado.
OBH also approves trainers for the Certified Addiction Counselor (CAC) required training classes and the curriculum for these classes.
DORA regulates addiction counselors in Colorado and is responsible for the following activities related to counselor certification and licensure:
For information and/or application regarding addiction counselor certification or licensure, please contact:
DORA (Department of Regulatory Agencies)
Mental Health Section, CAC Program
1560 Broadway, Ste. 1350
Denver, CO 80202
Correcting Common Myths:
Refer to the OBH Certified Addiction Counselor Clinical Training Program Handbook for Addiction Counselors (CAC/LAC) for training requirements (pages 20-24)!
For more information about becoming a licensed addiction counselor, please contact:
Mary McMahon, CAC Clinical Training Program Manager
Office of Behavioral Health
email@example.com | 303.866.7826
OBH manages the CAC Clinical Training Program that sets the standards and curriculum for training addiction counselors in Colorado. Within that program, OBH also has a process to approve qualified trainers and the curriculum they teach to deliver the training classes needed for certification and licensure. Trainers must be OBH-approved before providing any training and will be notified with an approval letter sent by regular mail.
Periodically, trainings will be offered for new and existing OBH approved trainers in order to roll out new programs, provide updates to core competencies for required classes, provide training for newly developed classes, and to provide additional training on classroom management and trainer skills.
Three required classes for the CAC I level certification are referred to as the core curriculum. They are Addiction Counseling Skills, Client Record Management and Principles of Addiction Treatment. A training of trainers for the core curriculum will be offered periodically by OBH for new trainers interested in becoming approved for these three classes. The curriculum, agenda and examination for all three classes is provided by OBH.
Training Requirements for CAC I, II, III
High school diploma/GED
Total training hours = 112
1,000 hours of clinically supervised work experience
3 hrs of clinical supervision per month for full-time work
CAC I training plus:
Total training hours = 126
Additional 2,000 hours of clinically supervised work experience (beyond CAC I requirement) for a total of 3,000 hours
3 hrs of clinical supervision per month for full-time work
Bachelor's Degree in a Behavioral Health Science
CAC II Certification plus:
Total training hours = 56
Additional 2,000 hours of clinically supervised work experience (beyond CAC II requirement) for a total of 5,000 hours
2 hrs of clinical supervision per month for full-time work
Training Requirements Summary for CAC II, III & LAC for Those Who Hold a Clinical Master’s or Doctorate Degree
Training classes required with a clinical Masters or Doctorate degree:
2,000 hours of clinically supervised work experience
Two hours of clinical supervision per month for full time work
NCACII or MAC National examination
Additional 1,000 hours for a total of 3000 hours clinically supervised work experience
Two hours of clinical supervision per month for full time work
MAC National examination
Must have a clinical Masters or Doctorate degree
Meet all requirements for the CAC III and passage of the MAC exam
Download the CAC Handbook
The Office of Behavioral Health has created a handbook designed to help guide those who wish to pursue an addiction credential in Colorado. The CAC Handbook provides information about these important subjects:
Download the Addiction Counselor Certification and Licensure Rules
Download the OBH Approved Trainer Handbook
Download a list of CAC Clinical Program Training Facilities
The State of Colorado is sponsoring a series of training courses in the Strategies for Self-Improvement and Change curriculum. This curriculum is an evidence-based, cognitive-behavioral treatment model for the substance abusing adult offender.
The Criminal Conduct and Substance Abuse Treatment Strategies for Self-Improvement and Change (SSC) series is a 3-day training. To attend the course, download the 2017-2018 SSC training locations and an application.
Integration of Medical and Behavioral Health Services for Vulnerable PopulationsMay 23, 2019, 8:30 a.m. - 12:00 p.m.
The workshop will focus on one integrated care model for gender non-conforming and transgender children, adolescents, and young adults and another integrated care model serving adolescents and young adults living with HIV or at-risk of acquiring HIV. The workshop will review literature on the effectiveness and explore the benefits and barriers to using integrated care models successfully.
View the event flyer or visit the registration page to sign up to attend.