Insert Annex A
City/Municipa
l Logo here Republic of the Philippines
City/Municipality of ____________________
Checklist for Certification of CBDRP Programs
I. Name of Community Based Drug Rehabilitation Program:
A. Municipality/ City/ Province: __________________________________________
B. Municipal/ City Anti-Drug Abuse Council Focal Person: _______
C. Email: ______________________________________________________
D. Contact Number: _____________________________________
II. Date of Certification: ___________________________________
A. Certified by: __________________________________________
B. Title/Position, Office: ___________________________________
C. Contact details: ________________________________________
Instruction: Pls. put a tick on each criterion complied with during validation.
PUBLIC HEALTH COMPONENT SERVICES CBDRP CERTIFICATION CRITERIA/
CHECKLIST FOR VALIDATION
1. PROMOTION 1. Any of the following PROMOTION
a. Knowledge on causes, ill effects, and services from (a) to (d):
consequences of substance use and
misuse. a. IEC materials, OR
b. Advocacy towards a healthy lifestyle free
from drugs and other gateway substances b. Brochures, OR
(i.e. tobacco and alcohol)
c. Advocacy towards healthy relationships c. Protocols
with family, friends, and community
d. Advocacy towards health-seeking
behavior to prevent progression of risky Remarks:
behavior
2. PREVENTION 1. Certificate of Completion on SBIRT
a. Screening Services – Screening Brief Training, AND
Intervention and Referral to Treatment
(SBIRT) and testing 2. Screening tool materials
Remarks:
3. TREATMENT for Moderate Risk for Drug 1. Certificate of Completion
Dependence and/or Mild Substance Use Disorder of Training, AND
a. Counselling for both individual and the
family 2. Schedule of Activities
Remarks:
4. REFERRALS for High Risk for Drug 1. Memorandum of Agreement for each
Dependence and with co-morbidities of (a) to (d)
a. Assessment Services – DDE by DOH- a. Assessment services
accredited physician
b. Treatment referral to Non-residential or b. Treatment referral to
Outpatient DATRC/ Recovery Clinic and Non-Residential DATRC
Residential DATRC RC AND
c. Treatment referral to psycho-socio- Residential DATRCs
spiritual services
d. Treatment referral of psychiatric and c. Treatment referral
medical comorbidities to specialty to psycho-socio-
services in hospitals spiritual services
d. Treatment referral of
psychiatric and
medical comorbidities
to specialty services in hospitals
Remarks:
