1. The SASSI and Other Assessment Tools
Diane A. Tennies, Ph.D., LADC
Lead TEAP Health Specialist
June 5, 2013

2. Learning Objectives
After 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 PRH
List commonly available assessment tools that are empirically validated and recommended for use in TEAP
Administer and interpret the SASSI3/SASSIA2
Begin to develop assessment protocols for their own TEAP programs

4. PRH 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 arrival
Formalized assessment measures (e.g., SASSI3 or SASSIA2), and clinical judgment to determine students’ level of risk for substance use
Collaboration 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

5. But Who Do We Assess?
Everyone?
Just a few?

6. Screening
Screening for disease has become a mainstay of today’s preventive health care.
SBIRT defined:
Screening for alcohol/drug problems with a validated brief questionnaire
Brief intervention by a professional who discusses alcohol and drug use issues with those who may be at risk
Referral to treatment, if warranted
Becoming a recommended best practice.
Increased screening allows clinicians to intervene early before they become too serious. How does this apply to JC?

7. What is the screening at JC?
Alert Questions on JC Health History Form
Urine toxicology screening
Clinical judgment during interactions
Review of SIF – CRAFFT
total score
specific items
Others?

8. Job 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

9. Reminder – 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)

11. When Further Assessment is Needed
What are the ‘critical elements’?
Multiple data sources
Therapeutic alliance
Increased time and effort with individual focus
Narrow focus to specific issue to assess – individualized
What else is in your ‘tool bag’?
What about validity of self-report and how do we enhance?
Reality of drug screening
Review the ‘data’ you have (653; SIF; other info in SHR)
Motivational Enhancement strategies – examples?

13. Value 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 retention
Early intervention means improved outcomes
Enhanced therapeutic alliance for future interventions
Utilization of your skills as the ‘addiction specialist’

14. Assessment Tools Options
These are well-established with adequate reliability and validity:
MAST
DAST
SASSI-3/SASSI-A2

15. Michigan Alcoholism Screening Test (MAST)
One of most widely used measures for alcohol abuse
25 items
Paper/pencil or interview formats
Takes total of 15 minutes to administer and score
Good psychometric properties

16. Drug Abuse Screening Test (DAST)
10, 20, or 28 item versions
Self-report with binary (yes or no responses)
Face valid*
Modified from MAST
Relatively good psychometric properties
*A test has face validity if it "looks like" it is going to measure what it is supposed to measure

17. Substance 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 minutes
Computer or hand scored
Overall accuracy in distinguishing people with substance dependence from those without is 94%

18. SASSI Specifics
One 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 questions
True/false side – asks statements which appear unrelated to substance use, such as ‘I have been tempted to leave home.’

19. Why Subtle Items?
Based on research showing that individuals with substance dependence diagnosis answered differently than the general population
Statistical analysis detected a set of questions which substance dependent individuals consistently answered differently
Not based on a theory of substance dependence
Does 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

20. More Specifics
Ten subscales (two face-valid scales and eight clinical subscales)
FVA (Face Valid Alcohol) – acknowledged use of alcohol
FVOD (Face Valid Other Drugs) – of other drugs
SYM – Substance Misuse Symptoms
Causes, consequences and correlates of substance misuse
RAP – random responding
OAT – obvious attitudes – characteristics commonly associated with substance misuse

21. More Specifics (cont.)
SAT – subtle attitudes – basic personal style similar to substance-dependent individuals
DEF – defensiveness – may or may not be related to substance misuse, may be either enduring trait or temporary reaction
SAM – supplemental addiction measure – supplements other scales and not used for clinical interpretation
FAM – family vs. controls – similarity to family members of substance dependant people
COR – correctional – similarity to people with extensive legal difficulties

22. Decision Rules FVA 18 or more FVOD 16 or more SYM 7 or more
OAT 10 or more
SAT 6 or more
Rule 6 -9 combinations of above

24. What Happens Next? Determine the level of risk –
Putting all the data together
Using clinical judgment to decide level
Is a ‘rating’ of low, medium, or high possible?
What is possible range of outcomes?
Brief intervention (using MI strategies) with everyone
Then consider:
Offering intervention services
MSWR (in collaboration with CMHC)

25. Brief Interventions: The Elements
Three Elements with acronym FLO:
Provide Feedback about assessment results
Ask 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

26. Document in the SHR Need to be efficient
Easily accessible to other Health and Wellness staff
Options?

27. Create a Summary Sheet for Rapid Review

28. Learning Objective - Revisited
List three reasons why the assessment process is an effective use of time/resources and consistent with the new PRH
Improved identification means improved retention
Early intervention means improved outcomes
Enhanced therapeutic alliance for future interventions
Utilization of your skills as the ‘addiction specialist’
List commonly available assessment tools that are empirically validated and recommended for use in TEAP
MAST
DAST
SASSI’s

29. Learning Objectives - Revisited
Administer and interpret the SASSI3/SASSIA2
Begin to develop assessment protocols for their own TEAP programs

30. Main:(800)
Clinical:(888)
Training:(800)
Tech Supt.:(888)

31. Wrapping Up