Presentation on theme: "The SASSI and Other Assessment Tools"— Presentation transcript:
1The SASSI and Other Assessment Tools Diane A. Tennies, Ph.D., LADCLead TEAP Health SpecialistJune 5, 2013
2Learning ObjectivesAfter this presentation, participants will be able to:List three reasons why the assessment process is an effective use of time/resources and consistent with the new PRHList commonly available assessment tools that are empirically validated and recommended for use in TEAPAdminister and interpret the SASSI3/SASSIA2Begin to develop assessment protocols for their own TEAP programs
4PRH 6.11 R1 (c)Assessment for identification of students at risk for substance use problems to include:Review of Social Intake Form (SIF) or intake assessment of all students performed by counseling staff within 1 week of arrivalFormalized assessment measures (e.g., SASSI3 or SASSIA2), and clinical judgment to determine students’ level of risk for substance useCollaboration with the Center Mental Health Consultant to determine when a MSWR or medical separation is appropriate and should be recommended for a student with substance use conditions
6ScreeningScreening for disease has become a mainstay of today’s preventive health care.SBIRT defined:Screening for alcohol/drug problems with a validated brief questionnaireBrief intervention by a professional who discusses alcohol and drug use issues with those who may be at riskReferral to treatment, if warrantedBecoming a recommended best practice.Increased screening allows clinicians to intervene early before they become too serious. How does this apply to JC?
7What is the screening at JC? Alert Questions on JC Health History FormUrine toxicology screeningClinical judgment during interactionsReview of SIF – CRAFFTtotal scorespecific itemsOthers?
8Job Corps Health History Form The Job Corps Health History Form (completed within 48 hours of a student’s arrival):Are you currently feeling stressed out and need to talk with someone today?*In the past 2 weeks, have you used alcohol or used drugs frequently or daily?*An affirmative answer these questions may signify a serious problem. A member of the medical and/or nursing team should review all questions on this form with the new student and refer as needed
9Reminder – CRAFFT Questions C-Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs? **R-Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?A-Do you ever use alcohol/drugs while you are by yourself, ALONE?F-Do you ever FORGET things you did while using alcohol or drugs?F-Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?T-Have you gotten into TROUBLE while you were using alcohol or drugs?Answers two or more = further assessment required
10**Car Question? This screens for the greatest public health problem Motor vehicle deaths are the leading cause of death among this age group (don’t have to be behind the wheel to die)
11When Further Assessment is Needed What are the ‘critical elements’?Multiple data sourcesTherapeutic allianceIncreased time and effort with individual focusNarrow focus to specific issue to assess – individualizedWhat else is in your ‘tool bag’?What about validity of self-report and how do we enhance?Reality of drug screeningReview the ‘data’ you have (653; SIF; other info in SHR)Motivational Enhancement strategies – examples?
13Value of an Assessment Process How are ‘high-risk’ students identified in TEAP now?Are there better ways to identify and intervene with the higher-risk students?What does screening and assessment ‘add’ to TEAP?Improved identification means improved retentionEarly intervention means improved outcomesEnhanced therapeutic alliance for future interventionsUtilization of your skills as the ‘addiction specialist’
14Assessment Tools Options These are well-established with adequate reliability and validity:MASTDASTSASSI-3/SASSI-A2
15Michigan Alcoholism Screening Test (MAST) One of most widely used measures for alcohol abuse25 itemsPaper/pencil or interview formatsTakes total of 15 minutes to administer and scoreGood psychometric properties
16Drug Abuse Screening Test (DAST) 10, 20, or 28 item versionsSelf-report with binary (yes or no responses)Face valid*Modified from MASTRelatively good psychometric properties*A test has face validity if it "looks like" it is going to measure what it is supposed to measure
17Substance Abuse Subtle Screening Inventory - 3 Initially published by G. Miller, Ph.D. in 1988 (initial adolescent version in 1990 for ages 12-18)Administered and scored in about 15 minutesComputer or hand scoredOverall accuracy in distinguishing people with substance dependence from those without is 94%
18SASSI SpecificsOne side has face valid items – asks about frequency of use of drugs/alcohol as well as presence of ‘known’ difficulties related to substance misuse = obvious questionsTrue/false side – asks statements which appear unrelated to substance use, such as ‘I have been tempted to leave home.’
19Why Subtle Items?Based on research showing that individuals with substance dependence diagnosis answered differently than the general populationStatistical analysis detected a set of questions which substance dependent individuals consistently answered differentlyNot based on a theory of substance dependenceDoes not matter why they answered as they did but rather research has shown that people who answer questions this way have a high probability of a substance dependence disorder
20More SpecificsTen subscales (two face-valid scales and eight clinical subscales)FVA (Face Valid Alcohol) – acknowledged use of alcoholFVOD (Face Valid Other Drugs) – of other drugsSYM – Substance Misuse SymptomsCauses, consequences and correlates of substance misuseRAP – random respondingOAT – obvious attitudes – characteristics commonly associated with substance misuse
21More Specifics (cont.)SAT – subtle attitudes – basic personal style similar to substance-dependent individualsDEF – defensiveness – may or may not be related to substance misuse, may be either enduring trait or temporary reactionSAM – supplemental addiction measure – supplements other scales and not used for clinical interpretationFAM – family vs. controls – similarity to family members of substance dependant peopleCOR – correctional – similarity to people with extensive legal difficulties
22Decision Rules FVA 18 or more FVOD 16 or more SYM 7 or more OAT 10 or moreSAT 6 or moreRule 6 -9 combinations of above
24What Happens Next? Determine the level of risk – Putting all the data togetherUsing clinical judgment to decide levelIs a ‘rating’ of low, medium, or high possible?What is possible range of outcomes?Brief intervention (using MI strategies) with everyoneThen consider:Offering intervention servicesMSWR (in collaboration with CMHC)
25Brief Interventions: The Elements Three Elements with acronym FLO:Provide Feedback about assessment resultsAsk student for their reaction and views about their own drug use. Listen carefully to encourage their thinking and decision-making process.Provide advice, and negotiate a decision about Options, including establishing a goal and developing an action plan
26Document in the SHR Need to be efficient Easily accessible to other Health and Wellness staffOptions?
28Learning Objective - Revisited List three reasons why the assessment process is an effective use of time/resources and consistent with the new PRHImproved identification means improved retentionEarly intervention means improved outcomesEnhanced therapeutic alliance for future interventionsUtilization of your skills as the ‘addiction specialist’List commonly available assessment tools that are empirically validated and recommended for use in TEAPMASTDASTSASSI’s
29Learning Objectives - Revisited Administer and interpret the SASSI3/SASSIA2Begin to develop assessment protocols for their own TEAP programs