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2000 Jordan Institute
for Families

Vol. 4, No. 2
May 1999

Work First, Qualified Substance Abuse Professionals (QSAP), and Collaboration

Because they seek to improve outcomes for families, North Carolina's departments of social services and mental health centers are working together as never before.

Work First, with its requirement that those involved in the program be screened for substance use problems, is a major contributor to these new interactions. To meet this substance-abuse screening criteria of Work First, mental health centers have been hiring new QSAPs, or Qualified Substance Abuse Professionals, often locating them on-site at DSS.

In an effort to shed some light on this new arrangement, Practice Notes interviewed several agencies in the Northeastern part of the state. What follows is a look at how the relationship between DSS and mental health changed as a result of this collaboration around Work First.

A Multi-County Effort

The Work First Program in the North Carolina's North Hampton, Bertie, Hertford, and Gates county DSS programs began in April 1998. At this time the mental health agency in the area, Ronoake/Chowan Human Services Center, and the DSS's met to work out a plan. A meeting was scheduled in which the staff from the various agencies were introduced and the referral process was explained.

In addition, the mental health agency conducted some training for DSS staff that included role playing, information about substance abuse and dependence, and an introduction to the AUDIT and the DAST, two tools used for substance abuse screening. Several months later these groups met again to discuss confidentiality, the referral process, and to explain the various roles people would have with Work First.

These meetings helped both agencies understand their respective legal constraints, including state and federal regulations. This meeting also helped the agencies connect on a more personal level as they spent time together, where previously they had not known each other.

At first DSS staff were somewhat ambivalent about the mental health aspects of the Work First Program. Behind this lay the fact that they did not feel qualified to use the AUDIT or the DAST, and because they had lots of other paperwork.


This ambivalence was eased by Heather Stoume, who was hired by the mental health agency as the QSAP for Work First. Early on Stoume sat in on some interviews to facilitate the screening process, made sure people knew her, explained what her role would be, and provided additional training to DSS staff members who missed the initial training session.

Heather puts herself "out there." She is direct about her dedication to the clients and her desire that the program work. She stays visible, makes herself available, and attends meetings. She communicates with DSS regularly regarding clients' progress, letting DSS know whether clients are in treatment and whether they are following the treatment plan. She's treated as a part of the DSS team.


Heather has set up days she will be in various clinics: she spends one day in each county and Fridays at the mental health center. She is shuffled around and sits where office space is available. Her phone number is posted all over the clinics and most people know her schedule.

Clients sign a release of information form so Heather can obtain information from DSS about the substance use screening results. Once a client is referred to her, she conducts the SUDS-4 (Substance Use Disorders Diagnostic Schedule - 4) which takes about an hour and a half to complete. If a client scores in the substance abuse or dependence range, an appointment is set up with a substance abuse counselor, and, if necessary, transportation is arranged.

Once a client has been referred to treatment, Heather follows up to make sure the client is attending his or her appointments and reports back to DSS. This is important because TANF (Temporary Assistance for Needy Families) benefits can be reduced if a client fails to participate in prescribed substance abuse treatment.


The Work First collaboration has helped the Ronoake/Chowan Human Services Center and the social service agencies involved develop a better understanding of each other's strengths and limitations. For example, DSS now knows more about the services offered by the mental health center, and the mental health center appreciates the amount of paperwork involved in a client case, as well as the strain associated with the large case loads in Work First.

And, by giving them the QSAP, Work First has expanded DSS's capacity by providing them with a professional to call on when they have questions related to mental health or substance use.


Personal Communications with: Wanda Piland, R.N., B.S.N., C., Adult Program Manager, Roanoke, Chowan and Human Services Center, Renee Shaw, B.S. Work First Employment Services Social Worker, North Hampton County Department of Social Services, Anna Sheyett, MSW, CCSW, Behavioral Healthcare Resource Program, Jordan Institute for Families, UNC-Chapel Hill School of Social Work, Heather Stoume, B.A., Substance Abuse Counselor, Roanoke/Chowan Human Services Center.

1999 Jordan Institute for Families