2022 Edition

Mental Health and/or Substance Use Services (CA-MHSU) 5: Clinical Counselling

The organization provides trauma-informed clinical counselling services that: 
  1. provide an appropriate level and intensity of support and treatment;
  2. recognize individual and family values and goals;
  3. accommodate variations in lifestyle; 
  4. emphasize personal growth, development, and situational change; and
  5. promote recovery, resilience, and wellness.


 Outpatient withdrawal management programs include a range of therapies (e.g., cognitive, behavioural, medical, and mental health therapies), provided to persons served on an individual or group basis. Services aim to enhance the person's understanding of addiction, manage their withdrawal symptoms, and connect them with an appropriate level of care for ongoing substance use treatment. The delivery of services will vary and depends on the assessed needs of the person and his or her treatment progress. 
NA The organization provides Diagnosis, Assessment, and Referral Services only.




Individuals and families who receive Mental Health and/or Substance Use Services improve social, emotional, psychological, cognitive, and family functioning to attain recovery and wellness.
Examples: Organizational self-assessments can help evaluate the extent to which organizations’ policies and practices are trauma-informed, as well as identify strengths and barriers in regards to trauma-informed service delivery and provision. For example, organizations can evaluate staff training and professional development opportunities and review supervision ratios to assess whether personnel are trained and supported on trauma-informed care practices.
Note: Recovery is a holistic process of change where individuals learn to overcome or manage their diagnosed symptoms and conditions in order to improve overall well-being and achieve optimal health.
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.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for evaluating level/intensity of care and follow-up
  • Procedures for accommodating the schedules and unique needs of individuals and families
  • Educational/informational materials
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records


CA-MHSU 5.01

Clinical counselling services promote whole-person wellness and help individuals and families  to develop the knowledge, skills, and supports necessary to:  
  1. manage mental health and/or substance use disorders; 
  2. cultivate and sustain positive, meaningful relationships with peers, family members, and the community; and 
  3. develop self-efficacy.
Examples: Working with individuals and families to strengthen their interpersonal skills may support the development and maintenance of their social support networks.  It may also be helpful for them to consider how to incorporate both give and take into their social relationships, since relationships will be more likely to endure if they are mutually satisfying and beneficial.


CA-MHSU 5.02

Personnel assist individuals and families to: 
  1. explore and clarify the concern or issue;
  2. voice the goals they wish to achieve;
  3. identify successful coping or problem-solving strategies based on their strengths, formal and informal supports, and preferred solutions; and
  4. realize ways of maintaining and generalizing gains.
Examples: Personnel can help to engage and motivate persons served in this process by demonstrating, for example: 
  1. sensitivity to their needs and personal goals;
  2. a non-threatening manner;
  3. respect for their autonomy, confidentiality, sociocultural values, personal goals, lifestyle choices, and complex family interactions;
  4. flexibility; and
  5. appropriate boundaries.


CA-MHSU 5.03

Clinical personnel: 
  1. determine the optimal level and intensity of care, including clinical and community support services;
  2. follow up when an evaluation for psychotropic medications and medication-assisted treatment is recommended; and
  3. use written criteria to determine when the involvement of a psychiatrist is indicated.


Element (c) does not apply to withdrawal management programs.


CA-MHSU 5.04

When working with children and youth, services are designed to: 
  1. focus on the family as a whole; 
  2. involve all family members to the extent possible; and 
  3. be provided at times that accommodate family members’ schedules and needs. 
NA The organization does not provide services to children and youth. 
Examples: Times that accommodate family members’ schedules may include, for example, evenings and weekends. Times that accommodate family members’ needs may include other days and times that family members identify as challenging and need support navigating (e.g., meal time, nap time, vacation days).


CA-MHSU 5.05

When providing family therapy, personnel help family members develop and hone new competencies through:  
  1. instruction and discussion about the topics and practices being targeted, why they are important, and their relevance to the family;  
  2. modeling of the practices and skills being targeted;  
  3. within-session practice that enables family members to use new skills and strategies with the worker present to intervene in the moment with coaching, positive reinforcement, or corrective feedback, as needed;  
  4. follow-up tasks that call for practice outside of the session; and  
  5. support in planning how to use skills and strategies in different situations, how to manage setbacks, and how to avoid future crises. 
NA The organization does not provide family therapy.
Examples: Although the topics addressed with individual families will vary based on the specific issues that precipitated their need for service, the following competencies could be developed: 
  1. communicating in a healthy and effective manner; 
  2. solving problems effectively; 
  3. managing conflicts; 
  4. coping with adversity, stress, and emotions; 
  5. maintaining and strengthening interpersonal relationships; 
  6. accessing needed services and support; 
  7. managing a household; 
  8. understanding child/youth development, including what is appropriate for different ages and developmental levels; 
  9. parenting in a sensitive and responsive manner designed to provide protection, meet basic needs, foster emotional security, and promote positive interactions, as appropriate to children’s ages and developmental levels;  
  10. establishing appropriate roles and boundaries; and 
  11. implementing age-appropriate techniques for providing supervision, setting limits, and managing behaviour, including negative or maladaptive behaviours.