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Press ENTER for next slide. 1 Screening & Assessment.

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1 Press ENTER for next slide. 1 Screening & Assessment

2 2 Screening

3 3 What is the screening? A screening is done as the client seeks services to best determine what the clients potential problems may be and to determine if a complete assessment is required. The screening asks basic questions about the clients drug/alcohol use and the severity of that use. The purpose is to determine if there is a probability of a substance related disorder. If it appears that there might be a problem, an assessment then follows. If it does not appear there is a problem, the client is then referred to a social services agency that can best meet his/her needs. In addition to a substance use screening, the client is also screened for high risk behavior that could lead to HIV, STD, TB or Hepatitis transmission. If the client is engaging in these behaviors he or she is referral for testing.

4 Press ENTER for next slide.4 Screening Instruments There are several different types of screening tools. Many agencies now use their own specially created tools and there is no one tool that is required. However, the tools used have a mechanism to help make a recommendation for assessment, education, or the client being sent home. The most commonly used tools are: However, the tools used have a mechanism to help make a recommendation for assessment, education, or the client being sent home. The most commonly used tools are: SASSI- SASSI- BHIPS Screening- Example Attached BHIPS Screening- Example Attached Agency Devised- Example Attached Agency Devised- Example Attached

5 Press ENTER for next slide.5 Collateral Information Often, if a client is not voluntarily seeking services, such as a referral from the criminal justice system or children's protective services, he/she is likely to give little information, offer vague answers, or deny any use at all. It is important that the referral source or a family member be given the opportunity to offer collateral information regarding the clients behavior. Not what they think is occurring, but what behavior they have observed the client engaging in.

6 High Risk Behaviors Texas Department of State Health Services (DSHS) wants each participant to be screened for high risk behavior that leads to the transmission of HIV, sexually transmitted diseases, tuberculosis, and hepatitis. This can be done with a short questionnaire. The screener must document,in a note, that the client was screened and referred for testing.

7 Press ENTER for next slide. 7 ASSESSMENT

8 8 What is the assessment? An ASSESSMENT is the gathering of relevant information about the client, their environment, their problem(s), and what they hope to accomplish through the therapeutic intervention. There are many types of assessments used, the most common are: Addiction Severity Index (ASI)- w ww.tresearch.org/resources/instruments.htm#top Addiction Severity Index (ASI)- w ww.tresearch.org/resources/instruments.htm#top BHIPS Assessment- See Example Attached BHIPS Assessment- See Example Attached General Psychosocial Assessment- See Attached General Psychosocial Assessment- See Attached

9 Press ENTER for next slide.9 Assessment Guides Documentation

10 Press ENTER for next slide.10 Goals of the Assessment Goals of the Assessment The assessment should answer the following questions: Is treatment of any kind required? Is treatment of any kind required? What are the relative merits of the intervention? What are the relative merits of the intervention? What types of treatment approaches might be appropriate? What types of treatment approaches might be appropriate? What is the depth of therapy needed? What is the depth of therapy needed? Who should the therapy involve? Who should the therapy involve? Have cultural issues been considered? Have cultural issues been considered?

11 Press ENTER for next slide.11 Goals of the Assessment The Assessment should answer these basic questions: Why is the client seeking treatment? Why is the client seeking treatment? How have these problems affected the clients life? How have these problems affected the clients life? What is maintaining these problems? What is maintaining these problems? What does the client hope to gain from treatment? What does the client hope to gain from treatment?

12 Press ENTER for next slide. 12 Who can conduct an Assessment? Licensed Counselor (LCDC, LPC, LMSW, Ph.D) Licensed Counselor (LCDC, LPC, LMSW, Ph.D) Registered Counselor Intern Registered Counselor Intern Both are: Knowledgeable to assess the specific needs of the client being served Knowledgeable to assess the specific needs of the client being served Trained in the use of applicable and appropriate tools Trained in the use of applicable and appropriate tools Culturally sensitive to the clients needs Culturally sensitive to the clients needs

13 Press ENTER for next slide.13 Parts of the Assessment Presenting Problem or Chief Complaint Presenting Problem or Chief Complaint Alcohol and Other Drug Use History (Use) Alcohol and Other Drug Use History (Use) Mental Health History (Mental/Emotional Functioning) Mental Health History (Mental/Emotional Functioning) Psychiatric and Chemical Dependency Treatment Psychiatric and Chemical Dependency Treatment Medical History (HIV, STD, TB, HEP) Medical History (HIV, STD, TB, HEP) Relationships with Family Relationships with Family Social/Leisure History (Activities) Social/Leisure History (Activities) Educational/Vocational Educational/Vocational Employment Employment Legal History Legal History Client Strengths and Limitations Client Strengths and Limitations Diagnosis and Recommendations Diagnosis and Recommendations

14 Press ENTER for next slide.14 Presenting Problem Asks the client: Asks the client: What brings you here today? What brings you here today? Why do you think you need treatment? Why do you think you need treatment?

15 Press ENTER for next slide. 15 History of the Problem Documentation should include the following: Documentation should include the following: When the client began experiencing the problem When the client began experiencing the problem Their perception of the cause of the problem Their perception of the cause of the problem Significant events that occurred with or at the time the problem began Significant events that occurred with or at the time the problem began Precipitants of the problem Precipitants of the problem

16 Press ENTER for next slide. 16 History of the Problem Documentation should include the following: Documentation should include the following: What maintains the problems presence What maintains the problems presence The problems course over time The problems course over time How the problem affects the clients ability to function How the problem affects the clients ability to function What the client has done to try to deal with the problem What the client has done to try to deal with the problem

17 Press ENTER for next slide.17 Alcohol and Drug Use Substances used in the past Substances used in the past Substances used recently Substances used recently Frequency/amount/duration Frequency/amount/duration Route of administration Route of administration Year or Age of first use Year or Age of first use Behavior related to obtaining substances Behavior related to obtaining substances Use or recovering from alcohol or other drugs Use or recovering from alcohol or other drugs Previous overdose, withdrawal, or adverse drug or alcohol reactions Previous overdose, withdrawal, or adverse drug or alcohol reactions Attempts to decrease/stop use Attempts to decrease/stop use History of previous substance abuse treatment received History of previous substance abuse treatment received

18 Press ENTER for next slide. 18 Mental Health History Can shed light on whether the current problem is part of a single or recurrent episode. Can shed light on whether the current problem is part of a single or recurrent episode. A progression of behavioral health problems over a period of time. A progression of behavioral health problems over a period of time. What treatment approaches have or have not worked. What treatment approaches have or have not worked. Clients willingness to engage in the treatment process. Clients willingness to engage in the treatment process. Gives an idea of current emotional functioning. Gives an idea of current emotional functioning.

19 Press ENTER for next slide. 19 Psychiatric & Chemical Dependency (CD) Treatment Any previous treatment Any previous treatment Dates of Service Dates of Service Type of Service Type of Service Outcome- did they complete? are they still going to treatment? Outcome- did they complete? are they still going to treatment? Aftercare Services Aftercare Services

20 Press ENTER for next slide. 20 Medical History At a minimum, document these: At a minimum, document these: any significant illnesses any significant illnesses hospitalizations hospitalizations past and current physical illnesses or conditions past and current physical illnesses or conditions breast or prostate cancer breast or prostate cancer diabetes diabetes hypertension hypertension injuries or disorders affecting the central nervous system injuries or disorders affecting the central nervous system any functional limitations any functional limitations HIV, STD, TB or Hepatitis exposure or contact HIV, STD, TB or Hepatitis exposure or contact cursory family history of significant medical problems cursory family history of significant medical problems

21 Press ENTER for next slide. 21 Family Relationships The family history should include: The family history should include: Spouse, children information Spouse, children information Relationship with spouse and/or children Relationship with spouse and/or children Family expectation of treatment Family expectation of treatment The occupation and education of parents The occupation and education of parents The number of siblings and their birth order The number of siblings and their birth order The quality of clients relationship to parents and/or siblings The quality of clients relationship to parents and/or siblings Significant extended family members Significant extended family members Substance use in family Substance use in family Child or Domestic Abuse Child or Domestic Abuse

22 Press ENTER for next slide. 22 Social & Leisure Components should include: Components should include: General number of friendships General number of friendships Types of friendships Types of friendships Participation in team sports Participation in team sports Involvement in clubs Involvement in clubs Social activities- main form of socialization and leisure Social activities- main form of socialization and leisure Involvement in religion, political or gang activities Involvement in religion, political or gang activities Opportunities requiring interpersonal interactions Opportunities requiring interpersonal interactions Experiences stemming from being a member of a racial or ethnic minority Experiences stemming from being a member of a racial or ethnic minority

23 Press ENTER for next slide.23 Educational & Vocational Educational/Vocational history can give: Educational/Vocational history can give: Rough estimate of the clients level of intelligence Rough estimate of the clients level of intelligence Aspirations, goals, ability to gain from learning experiences Aspirations, goals, ability to gain from learning experiences Willingness to make a commitment Willingness to make a commitment Amount of perseverance Amount of perseverance Ability to delay gratification Ability to delay gratification Information should include: Information should include: Highest grade completed Highest grade completed Graduation status Graduation status Feeling regarding education/vocational training Feeling regarding education/vocational training Willingness to attend more (school or training) in future Willingness to attend more (school or training) in future

24 Press ENTER for next slide.24 Employment Employment history can: Employment history can: be useful in developing an effective treatment plan be useful in developing an effective treatment plan give insight into the clients ability to get along with others and take direction give insight into the clients ability to get along with others and take direction show clients ability for assuming the role of a client show clients ability for assuming the role of a client show compliance with treatment recommendations show compliance with treatment recommendations Employment history should include: Employment history should include: Last job held Last job held Length of longest employment Length of longest employment Job preference Job preference Military experience Military experience Termination for job reason (if applicable) Termination for job reason (if applicable)

25 Press ENTER for next slide. 25 Legal History Current legal problems Current legal problems probation probation parole parole awaiting trial/sentencing awaiting trial/sentencing recently released from jail/prison recently released from jail/prison Complications with legal situation Complications with legal situation positive UA positive UA Are legal problems directly related to substance use? Are legal problems directly related to substance use?

26 Press ENTER for next slide. 26 Client Strengths Force clients to consider that their psychological assets can have therapeutic value(s) in themselves. Force clients to consider that their psychological assets can have therapeutic value(s) in themselves. Strength-based assessments can serve as an intervention before formal treatment actually begins. Strength-based assessments can serve as an intervention before formal treatment actually begins. Can help build self-esteem and self-confidence. Can help build self-esteem and self-confidence. Reinforce the clients efforts to seek help. Reinforce the clients efforts to seek help. Increase their motivation to return to engage in the work of treatment. Increase their motivation to return to engage in the work of treatment.

27 Press ENTER for next slide. 27 Diagnosis Must be a Five Axial Diagnosis: Must be a Five Axial Diagnosis: Must use criteria in DSM-IV-TR Must use criteria in DSM-IV-TR Each Axial Diagnosis must be supported in a body of assessment by describing behavior that demonstrates the DSM-IV diagnostic criteria Each Axial Diagnosis must be supported in a body of assessment by describing behavior that demonstrates the DSM-IV diagnostic criteria You must determine if the client has a substance-related disorder, if not, they are not eligible for treatment services You must determine if the client has a substance-related disorder, if not, they are not eligible for treatment services

28 Press ENTER for next slide.28 DSM-IV Multi-axial Diagnostic System Axis I (Clinical Disorders, other conditions that may be a focus of attention) Examples: Substance abuse, substance dependence, anxiety disorders, mood disorders, schizophrenia Axis I (Clinical Disorders, other conditions that may be a focus of attention) Examples: Substance abuse, substance dependence, anxiety disorders, mood disorders, schizophrenia Axis II (Personality disorders, mental retardation) Examples: Borderline personality disorder, antisocial personality disorder, avoidant personality disorder, mental retardation Axis II (Personality disorders, mental retardation) Examples: Borderline personality disorder, antisocial personality disorder, avoidant personality disorder, mental retardation Axis III (General medical conditions) Examples: Cancer, Hypertension, Diabetes, Migraines, Chronic Pain, Injuries Axis III (General medical conditions) Examples: Cancer, Hypertension, Diabetes, Migraines, Chronic Pain, Injuries Axis IV (Psychosocial and environmental problems) Examples: Problems with primary support group, occupational problems, problems relating to social environment Axis IV (Psychosocial and environmental problems) Examples: Problems with primary support group, occupational problems, problems relating to social environment Axis V (Global assessment of functioning) Example: GAF Score Axis V (Global assessment of functioning) Example: GAF Score

29 Press ENTER for next slide.29 Recommendations The assessment must include: The assessment must include: The clinical recommendations The clinical recommendations counseling counseling education education treatment treatment Recommendation for treatment must indicate the level of care Recommendation for treatment must indicate the level of care Detox Detox Residential Residential Outpatient Outpatient What are the recommended: What are the recommended: services services length of stay length of stay intensity of services intensity of services Diagnostic Justification Summary Diagnostic Justification Summary

30 Press ENTER for next slide.30 Treatment Eligibility To be eligible for treatment, clients must meet the diagnostic criteria for substance abuse or substance dependence. If they do not meet the diagnostic criteria, as supported and documented in the assessment, you can not admit the client into treatment, they must be referred for education or sent home. Once it is determined that they meet the diagnostic criteria the level of treatment is determined by the Texas Department of Insurance admission placement criteria and if DSHS is to pay for the services, determined by DSHS placement criteria.

31 Admission Once the clinician has determined that the client meets the diagnostic, level of care, and financial eligibility criteria for admission, they may begin the admission process. It is important that the admission be justified in writing by acknowledging the diagnostic criteria has been met, the placement criteria has been met, and the financial criteria has been met. The decision to admit should be supported by the assessment, and the assessment is always done before an admission.

32 Press ENTER for next slide.32 Other Issues to Consider Problem Complexity Problem Complexity Readiness to Change Readiness to Change Social Supports Social Supports Coping Styles Coping Styles Motivation Motivation

33 Press ENTER for next slide. 33 Problem Complexity Presenting problems can have an important Presenting problems can have an important bearing on the treatment planning process. bearing on the treatment planning process. Problem complexity can be facilitated by Problem complexity can be facilitated by historical information about other aspects of the historical information about other aspects of the clients life. clients life. Historical information can allow for the revelation of recurrent patterns or themes arising within Historical information can allow for the revelation of recurrent patterns or themes arising within objectively different, but symbolically related, objectively different, but symbolically related, relationships. relationships.

34 Press ENTER for next slide. 34 Non-Complex Problems The following may be exhibited or reported during the assessment: The following may be exhibited or reported during the assessment: Chronic habits and/or transient responses. Chronic habits and/or transient responses. Behavior repetition maintained by inadequate knowledge or by ongoing situational rewards. Behavior repetition maintained by inadequate knowledge or by ongoing situational rewards. Behaviors having a direct relationship to initiating events. Behaviors having a direct relationship to initiating events. Behaviors that are situation specific. Behaviors that are situation specific.

35 Press ENTER for next slide. 35 Complex Problems The following may be exhibited or reported during the assessment: The following may be exhibited or reported during the assessment: Behaviors are repeated as themes across unrelated or dissimilar situations. Behaviors are repeated as themes across unrelated or dissimilar situations. Behaviors are ritualized (yet self-defeating) attempts to resolve dynamic or interpersonal conflicts. Behaviors are ritualized (yet self-defeating) attempts to resolve dynamic or interpersonal conflicts. Current conflicts are expressions of the clients past rather than present relationships. Current conflicts are expressions of the clients past rather than present relationships. Repetitive behaviors results in suffering rather than gratification. Repetitive behaviors results in suffering rather than gratification. Symptoms have a symbolic relationship to initiating events. Symptoms have a symbolic relationship to initiating events. Problems are enduring, repetitive and symbolic manifestations of characterlogical conflicts. Problems are enduring, repetitive and symbolic manifestations of characterlogical conflicts. (Patrick, 32)

36 Press ENTER for next slide. 36 Readiness to Change Prochaska, DiClemente and colleagues: Five Stages of Change: Prochaska, DiClemente and colleagues: Five Stages of Change: Pre-Contemplative Pre-Contemplative Contemplative Contemplative Preparation Preparation Action Action Maintenance Maintenance

37 Press ENTER for next slide. 37 Prochaskas Stages of Change: Pre-contemplative Little or no awareness of problems Little or no awareness of problems Little or no serious consideration or intent to change Little or no serious consideration or intent to change Often presents for treatment at the request of/or pressure from another party Often presents for treatment at the request of/or pressure from another party Change may be exhibited when pressure is applied but the client reverts to previous behavior(s) when pressure is removed. Change may be exhibited when pressure is applied but the client reverts to previous behavior(s) when pressure is removed. Resistant to recognizing or changing the problem is the hallmark of the pre-contemplative stage.Resistant to recognizing or changing the problem is the hallmark of the pre-contemplative stage.

38 Press ENTER for next slide. 38 Prochaskas Stages of Change: Contemplative Awareness of problem and serious thoughts about working on it. Awareness of problem and serious thoughts about working on it. No commitment to begin to work on it. No commitment to begin to work on it. Weighing pros and cons of the problem and its solution. Weighing pros and cons of the problem and its solution. Serious consideration of problem resolution is the hallmark of the contemplation stage. Serious consideration of problem resolution is the hallmark of the contemplation stage.

39 Press ENTER for next slide. 39 Prochaskas Stages of Change: Preparation Intention to take serious, effective action in the near future (e.g., within a month). Intention to take serious, effective action in the near future (e.g., within a month). Has already made small behavioral changes. Has already made small behavioral changes. Decision making is the hallmark of this stage. Decision making is the hallmark of this stage.

40 Press ENTER for next slide. 40 Prochaskas Stages of Change: Action Overt modification of behavior, experiences or environment in an effort to overcome the problem. Overt modification of behavior, experiences or environment in an effort to overcome the problem. Modification of problem behavior to an acceptable criterion and serious efforts to change are the hallmarks of this stage. Modification of problem behavior to an acceptable criterion and serious efforts to change are the hallmarks of this stage.

41 Press ENTER for next slide.41 Prochaskas Stages of Change: Maintenance Continuation of change to prevent relapse Continuation of change to prevent relapse Consolidate the gains made during the action stage. Consolidate the gains made during the action stage. Stabilizing behavior change and avoiding relapse are the hallmarks of this stage. Stabilizing behavior change and avoiding relapse are the hallmarks of this stage.

42 Press ENTER for next slide.42 Potential Resistance to Therapeutic Influences Two different types of resistance exists: Two different types of resistance exists: Resistance Resistance a state-like quality in which clients fail to comply with external recommendations or directions. a state-like quality in which clients fail to comply with external recommendations or directions. Reactance Reactance a more extreme trait-like form of resistance that stems from the clients feelings that their freedom or sense of control is being challenged by outside forces. This is manifested as active opposition. a more extreme trait-like form of resistance that stems from the clients feelings that their freedom or sense of control is being challenged by outside forces. This is manifested as active opposition.

43 Press ENTER for next slide.43 Social Supports Objective social supports can be assessed from external evidence of resources available to the client, such as marriage, physical proximity to relatives, network of identified friends, membership in organizations and involvement in religious activities. Also includes the quality of social relationships.

44 Press ENTER for next slide.44 Coping Styles Coping style is defined as: Coping style is defined as: an enduring trait that relates to the way one copes with (handles) personal or interpersonal threats. an enduring trait that relates to the way one copes with (handles) personal or interpersonal threats. Two identified coping styles: Two identified coping styles: internalization internalization externalization externalization

45 Press ENTER for next slide.45 Internalization This style of coping is suggested in clients who tend to: This style of coping is suggested in clients who tend to: Avoid, deny, repress, or compartmentalize sources of anxiety Avoid, deny, repress, or compartmentalize sources of anxiety Be overly introverted, introspective, self-critical, and self-controlled Be overly introverted, introspective, self-critical, and self-controlled Be emotionally constricted Be emotionally constricted

46 Press ENTER for next slide. 46 Externalization This style of coping is suggested in clients who tend to: This style of coping is suggested in clients who tend to: Directly avoid, rationalize, project or act-out onto their environment(s). Directly avoid, rationalize, project or act-out onto their environment(s). Exhibit a degree of insensitivity to their own and others feelings. Exhibit a degree of insensitivity to their own and others feelings. Be spontaneous, impulsive, extraverted, and sometimes manipulative. Be spontaneous, impulsive, extraverted, and sometimes manipulative.

47 Press ENTER for next slide.47 Motivation to Change How to determine the clients level of motivation to change: How to determine the clients level of motivation to change: Is the client seeking treatment from their own desire for help or from the request/demand of another? Is the client seeking treatment from their own desire for help or from the request/demand of another? What is the clients stated willingness to be actively involved in the treatment process? What is the clients stated willingness to be actively involved in the treatment process? What is the clients subjective distress and reactance? What is the clients subjective distress and reactance? What is the clients readiness for, or stage of, change? What is the clients readiness for, or stage of, change?

48 Press ENTER for next slide. 48 Motivation to Change Factors that should be considered in the evaluation of motivation to engage in treatment: Factors that should be considered in the evaluation of motivation to engage in treatment: A willingness to participate in the diagnostic evaluation. A willingness to participate in the diagnostic evaluation. Honesty in reporting about oneself and ones difficulties. Honesty in reporting about oneself and ones difficulties. Ability to recognize that the symptoms experienced are psychological in nature. Ability to recognize that the symptoms experienced are psychological in nature. Introspectiveness and curiosity about ones own behavior and motives. Introspectiveness and curiosity about ones own behavior and motives. Openness to new ideas, with a willingness to consider different attitudes. Openness to new ideas, with a willingness to consider different attitudes. Realistic expectations for the results of treatment. Realistic expectations for the results of treatment. Willingness to make a reasonable sacrifice in order to achieve a successful outcome. Willingness to make a reasonable sacrifice in order to achieve a successful outcome.

49 Press ENTER for next slide. 49 Involving Others The client's family is an important factor in the client's involvement in, and treatment for, substance use disorders. The client's family is an important factor in the client's involvement in, and treatment for, substance use disorders. Therefore, it is critical to form a therapeutic alliance with the family to the fullest extent possible, and to involve the family in the assessment process. Therefore, it is critical to form a therapeutic alliance with the family to the fullest extent possible, and to involve the family in the assessment process. If there is evidence that the client is being abused at home, the family should still be questioned about the matter. If there is evidence that the client is being abused at home, the family should still be questioned about the matter. It is important to pursue what is known about possible abuse from the parents, even the abusing parent, as well as other family members (e.g., siblings). It is important to pursue what is known about possible abuse from the parents, even the abusing parent, as well as other family members (e.g., siblings).

50 Press ENTER for next slide.50 Involving Others- Continued The assessment should not be considered complete until there has been time to assess the traditionally defined family and others identified by the court as legal custodians who can speak for the best interests of the client, as well as the family that is defined by the young person.

51 Press ENTER for next slide.51 Involving Others- Continued If other people, such as the client's family, are involved in the assessment process, the assessor should determine the order of the interviewing process. For example, it may be advisable to first interview the young person in private, then the parent(s) in private, then with the group as a whole, being sure to tell each person that no information given in confidence will be shared with the entire group unless prior permission is granted. This strategy will maximize comfort and confidentiality.

52 Press ENTER for next slide. 52 Setting The assessment should be conducted in an office or other site where confidentiality can be ensured and where the client can feel comfortable, private, and secure. The validity of information provided by the client may depend on the setting (especially if the setting is seen by the client as adversarial or threatening), the level of trust between the client and the assessor, and the client's understanding of the potential use and audience for the information he is about to divulge. If the client feels that he will be overheard by others in the assessor's office, or that providing information will result in punishment, he is unlikely to tell the full truth. If an interview is conducted in a detention center, the juvenile should be assured that no one in authority at the center can overhear the interview.


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