Principles of Care and Practice Guidance

The Bureau of Substance Addiction Services (BSAS) actively promotes ways to improve practice in prevention, treatment and recovery systems of care.

Table of Contents

Principles of Care

Principles of Care in Prevention, Treatment and Recovery l (DOC)
BSAS Principles of Care are built on national standards of care.  The Principles are intended as base reference points in program and service design, and implementation.

Principles of Care and Practice Guidance l (DOC)
These Practice Guidance papers describe best practices. They show why and how practice in specific areas can improve. Substance use disorder service providers can use these papers to assess and improve their programs and services.  Consumers and their families can use them to understand what best practices should look like. Each paper has summaries, with embedded links, of research and resources, as well as a link to provide feedback to BSAS.

Co-Occurring Disorders

Effective Treatment for Persons with Co-Occurring Disorders l (DOC)
BSAS promotes integrated treatment of persons with both substance use  and mental health disorders. Close to half of those with a known diagnosis of one disorder also have the other one (co-occurring disorders).  Yet, research shows that fewer than 7% of people with co-occurring disorders receive treatment for both conditions. This means higher risks of relapse, hospital stays, homelessness and incarceration. This Practice Guidance summarizes key elements of care, and guides treatment programs to respond fully and effectively to persons with co-occurring disorders.

Infectious Diseases and Substance Use

Infectious Diseases and Substance Use: Integrated Risk Assessments | (DOC)
Opioid misuse and addiction have added to the rise of infectious diseases and related conditions due to injection drug use. BSAS is committed to ensure coordinated and integrated ways to address the link between addiction and infectious diseases. This Practice Guidance can help substance use disorder treatment providers understand and integrate behavioral risk assessments, and appropriate service referral for infectious diseases, for those who use their services.

Medication Assisted Treatment for Adults

Integrating Medication in Behavioral Treatment l (DOC)
Each person’s health is affected by life experiences and environment. BSAS believes substance use disorder treatment should respond to the whole person. This Practice Guidance helps treatment providers understand and integrate properly prescribed medication as part of effective  treatment plans.

English: Pregnancy and Medication-Assisted Treatment – Information and Support for Pregnant Women in Recovery l (DOC)

Spanish: Pregnancy and Medication-Assisted Treatment – Information and Support for Pregnant Women in Recovery l (DOC)

Special Populations

Access for Persons with Disabilities l (DOC)  
BSAS works to ensure access to, and participation in, substance use prevention, treatment and recovery services for persons with disabilities. This Practice Guidance describes the key role the Access Coordinator has to reach these goals in treatment programs. It also gives a summary of research and best practices, with links to useful resources. 

Treatment Services for Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) Adults l (DOC)
Access to quality treatment should not vary due to a person’s gender identity or sexual orientation. This module describes the range of treatment considerations, and best treatment practices for Lesbian, Gay, Bisexual, Transgender and Queer/Questioning adults.

Treatment Services for Older Adults l (DOC)
BSAS promotes excellent, effective treatment across the life span. This Practice Guidance outlines best ways to provide treatment for older adults.

Engaging Veterans in Treatment l (DOC
Engaging Veterans in Treatment Slide Presentation (PPTX)
This Practice Guidance highlights the importance of understanding the experiences, strengths and needs of those who have served in the U.S. Military. That can help treatment providers more effectively engage veterans in treatment, and support recovery for them and for their families.

Treatment Services for Pregnant and Postpartum Women l (DOC)
Pregnant substance using women are a priority population for BSAS.  This Guidance describes the needs and vulnerabilities of pregnant and postpartum women. It also notes administrative actions and clinical skills needed to engage and treat pregnant women, and their families.   Resources, with web links, are provided.

English: Pregnancy and Medication-Assisted Treatment – Information and Support for Pregnant Women in Recovery l (DOC)

Spanish: Pregnancy and Medication-Assisted Treatment – Information and Support for Pregnant Women in Recovery  l (DOC)

Stimulant Use Disorder Treatment

Stimulant Use Disorder Treatment Guidance (PDF) l (DOCX)
BSAS recognizes the challenge that stimulant use poses to many individuals and that care for stimulant use disorders has lagged behind care for other substance use disorders. This Practice Guidance serves to inform addiction treatment providers across the Commonwealth of Massachusetts of existing tools to implement evidence-informed strategies on the management of stimulant use disorder in program settings.

Tobacco and Nicotine–Part of All Treatment

Integration of Tobacco and Nicotine Into Substance Use Treatment Services l (DOC)
Tobacco-related diseases are the leading cause of death among persons treated for a substance use disorder.  A tiered systems approach can address health effects in the BSAS treatment population and its workforce.  This Practice Guidance describes the risks to recovery when use of tobacco/nicotine-related products continues.  It also describes ways to integrate best practices to address use as part of the comprehensive system for treating addictive disorders.

Treatment Services for Adults

Drug Screening as a Treatment Tool (PDF) l (DOC)
This Practice Guidance explores the use of drug screening in substance use disorder  treatment.  It focuses on evidence of effectiveness and on tailoring care to the needs of the individual. It includes summaries of research and guidance  on ways to ensure that drug screening supports engagement in treatment and recovery.

Integrating Opioid Overdose Prevention Strategies into Treatment (PDF) | (DOCX)
Preventing opioid overdose is a priority for the Bureau. Addressing opioid overdose prevention in treatment can reduce risk and increase safety. This Practice Guidance provides information and resources for organizational readiness and staff training. The intent is that overdose prevention, recognition and response are included in all stages of treatment.

Making Treatment Culturally Competent (PDF) l (DOC)
This Practice Guidance describes how to integrate cultural competence into substance use disorder treatment. This can reduce disparities, support best practices and improve outcomes. Equitable access to and engagement in treatment and recovery – a fundamental BSAS Principle of Care – are critical.

Partnerships with DCF (PDF) l (DOC)
Cooperation among providers, a BSAS priority, is important when substance use disorder weakens parents’ ability to care for their children.  This Guidance describes actions providers, staff, and DCF (Massachusetts Department of Children and Families) staff can take to build and maintain partnerships that promote family recovery and child safety.

Responding to Relapse (PDF) l (DOC)
BSAS promotes efforts to respond to relapse in ways that support ongoing participation in treatment.  This module describes practices that aim to keep individuals engaged in treatment while they work toward abstinence and recovery.

Trauma Informed Care Practice Guidance (PDF) | (DOCX)
This Practice Guidance explores the importance of Trauma Informed Care in substance use disorder treatment programs, with particular attention to drug screening, physical assessments, and safety checks. Included are principles, guidance, and resources to ensure the design and integration of systems which promote trauma informed services in BSAS Licensed and Approved treatment settings.

Youth and Young Adults

Treatment Services For Youth and Their Families l (DOC)
BSAS supports a comprehensive and effective system of care for youth and their families. This Practice Guidance outlines best ways to respond to specific issues affecting youth and their families.

Engaging Young Adults and Their Families in Treatment l (DOC)
BSAS has built a comprehensive and developmentally appropriate system of care for young adults and their families. This Practice Guidance explores some of the developmental and social behaviors of young adults and outlines how best to engage them and their families in treatment.

Medication Assisted Treatment for Adolescents and Young Adults l (DOC)
Specific to opioid use disorders (OUD), BSAS recognizes and supports Medication Assisted Treatment (MAT) combined with behavioral interventions.  MAT can support adolescents and young adults to achieve sobriety and engage in long-term recovery. This Practice Guidance focuses on youth ages 16 to 24 with identified OUD. The aim is to help service providers to better engage, retain, and support this population’s treatment process.

Serving LGBTQ Youth and Young Adults and Their Families l (DOC)
Youth and young adults, a priority for BSAS, are at high risk for substance-related disorders. Lesbian, Gay, Bisexual, Transgender and Queer/Questioning youth and young adults face even greater risks due to harassment, threats, violence and rejection. BSAS is committed to ensuring that LGBTQ youth and young adults, and their families have equal access to quality services. This Practice Guidance describes the risks this population faces, and best practices to engage these youth and young adults, and their families.

Behavior Intervention and Support Guidance | (DOCX)
The Department of Public Health (DPH) and the Bureau of Substance Addiction Services (BSAS) are committed to building a comprehensive and effective system of care for youth and young adults and their families.  The Behavior Intervention and Support Guidance was developed to align with the Department of Children and Families (DCF) and Department of Mental Health (DMH) guidelines and the Department of Early Education and Care (EEC) regulations and policies as it relates to youth residential programs.

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