Domain I - Screening, Assessment, and Engagement Flashcards
What is critical to early intervention or prevention of addiction?
Effective assessment of drug or alcohol use
What 3 skills are essential during clinical evaluation?
1) Establishing rapport; 2) creating a welcome atmosphere; and 3) assists in motivating and engaging the client
How does the initial screener/counselor need to be perceived?
Respectful, non-judgmental and attentive
What does engagement mean?
Making a connection between client and counselor
What is the first goal of the initial interview?
Establishing trust, rapport, and effective communication with the client
What is the second goal of the initial interview?
Facilitating the client’s understanding of the screening and assessment process.
What is the third goal of the initial interview?
Exploring the client’s problems and expectations
What is the fourth goal of the initial interview?
Determining whether further assessment is necessary
What is the first step in creating an effective relationship with client and counselor?
Make them feel comfortable
What are the 3 key elements in the drug recognition process?
1) Identify that individual’s physical responses deviate from the norm; 2) Ruling out a non-drug reason for deviations; and 3) Use diagnostic procedures to determine categories of drugs to cause impairments
How does stigma affect the interview climate?
May be reluctant to participate in screening interview
How can stigma be overcome in the interview climate?
Acknowledge the negative feelings about the stigma
How do expectations affect the interview climate?
Expectations may influence the client’s behavior and motivation.
How can the effect of expectations be managed in the initial interview climate?
Help set positive expectations
How does likability affect the initial interview?
Some clients have better relationship/social skills than others. This makes them more likely to be open than others.
How does the initial impression affect the initial interview?
Clients are more likely to disclose with someone they had a positive first impression with.
How does a counselor’s professional manner affect the initial interview?
Client’s want to be taken seriously; the counselor’s professionalism conveys this.
How does the environment affect the initial interview?
Sets the stage for the mood during the interview
What is rapport?
A sense of having connection with the other person.
How is rapport established?
Active listening; credibility/dependability; and respect and responsiveness.
How does the counselor’s emotions affect rapport?
Management of feelings towards the client is necessary for good rapport.
How effect does the counselor’s supportive words have on a client?
Build’s self-esteem and encourages the client.
What can the counselor do to show support?
Reinforce, sustain, and encourage appropriate expression of emotions.
How should a counselor use reassurance?
Use it only when appropriate. (IE don’t tell someone everything is going to be if it is not)
What is empathy?
Understanding the shared feelings and hope that something can be done about a situation.
What is sympathy?
Does not share feelings and conveys hopelessness.
What is acceptance in regards to the helping relationship?
A counselor conveys acceptance of a client despite any negative things they may have done.
What are the three basic components of information gathering?
Listening, questioning, and observing
What is active listening?
An intentional feedback loop between the counselor and the client
What are the specific components of active listening?
Reflecting, clarifying, focusing, and summarizing?
What does reflecting entail in active listening?
verbally restating the content of what the client has said.
What does clarifying entail in active listening?
Rephrasing what the client has said to improve understanding
What does focusing entail in active listening?
Helping to direct the client’s attention to a single topic
What does summarizing entail in active listening?
putting together key ideas and feelings into a brief statement
What is the function of questioning?
Using questions for clarification in order to understand the client, to motivate the client to pursue a specific topic and to help clarify his thoughts.
What is the benefit of open ended questions?
Client can’t answer with a yes or no and encourages client to express feelings and convey information.
What type of question should be avoided?
Why?
What is the benefit of observation?
Observe non-verbal information
What sort of things are reflected in non-verbal information?
state of mind, body image, self concept, or culture
What is motivational interviewing?
A style of interaction to facilitate change
When was motivational interviewing first used in substance abuse treatment?
1980s
What type of approach is Motivational Interviewing?
Person centered
How does motivational interviewing work?
Exploring and resolving ambivalence
What is a screening?
The process by which the counselor, client, and collateral review the current situation, symptoms, and other information.
What is the first step in addressing substance use?
Screening
What is the screening’s role in determining treatment?
Screening determines whether further intervention is needed and what level of care.
What is the goal of screening?
Identify individuals with substance use or related service needs.
What is the role of screening in the general public?
Determine the presence or absence of a substance use disorder.
What is the role of screening in client’s already at risk?
Determine severity of the problem and need for comprehensive assessment.
What sort of information gathering tools are used during screening?
Screening instruments, lab tests, clinical interviews, and personal contact.
What factors affect a screening?
Circumstances regarding contact, demeanor and behavior, signs of intoxication, physical signs of drug use or self-harm, and information offered spontaneously.
What are the guidelines for a successful screening?
Conducted on persons at risk in a variety of symptoms; collaboration among agencies; sensitive to individual differences; brief; and gather information from multiple sources.
What are examples of standardized screening instruments?
CAGE, GAIN-SI, and Michigan Alcohol Screening Test (MAST)
What settings are standardized screening instruments often used?
doctor’s office, ERs, and community health settings.
What things do standardized screening instruments evaluate?
Frequency and intensity of drug/ETOH use.
What question are screenings designed to answer?
Is it likely there is a substance use problem present and is additional screening needed?
How can observations assist the screening/assessment process?
Observe family members, clinicians, teachers, law enforcement, and others in their interactions with the client.
What is common during screenings which negatively impacts outcomes?
Denial and minimization
When are clients less likely to use denial?
When the atmosphere is non-threatening.
How can fear of prosecution or other sanctions be overcome?
Assurances of confidentiality
What is the purpose of assessment?
Defining the nature of the problem, determining a diagnosis, and developing treatment recommendations.
Who typically performs screenings?
Entry level counselors, child welfare, and public health.
Who is typically responsible for assessments?
Experienced and credentialed staff.
What information does assessment look at?
Historical and situational factors contributing to onset of use; patterns of use; signs and symptoms of SUD; and consequences of use.
In addition to substance use disorders, what else does the assessment look for?
Co-occurring disorders; interpersonal, physical, or spiritual problems; financial and legal difficulties; and other issues affecting addiction.
How are co-occurring disorders best treated?
With integrated treatment.
How can the counselor fully motivate and engage the client in assessment and treatment process?
By using a client centered approach.
What does the initial assessment lead to?
Recommendations for treatment and treatment planning.
How often should assessment be completed?
On an ongoing basis.
What should the counselor watch for and document during treatment?
Changes in client status and response to treatment.
What tools are used during assessment?
Standardized interventions, structured interviews, and self-administered tests.
What two factors should guide the tests that are selected for assessment?
Reliability and validity
What is validity?
The test acutely measures what it intends to measure.
What is reliability?
The test produces stable results.
What is the benefit of using multiple sources of information during assessment?
Obtain relevant and related information to establish eligibility and appropriateness and to facilitate the assessment process.
What other sources are useful in triangulating data during assessment?
Collateral, written reports and records from schools, employers, criminal justice, and previous treatments.
What is necessary to contact collateral for additional information?
Written Release of information/consent
Why is it necessary to use multiple sources of information during assessment?
Avoid minimization and exaggeration.
What should assessors consider when obtaining information from collateral?
Validity of information vs client report.
What is the benefit of using previous treatment records?
It is generally the most objective source.
What is the difficulty of using previous treatment records and other service records?
May be out-of-date or no longer acurate
How is the assessment interview different from a screening interview?
Assessment is generally more in depth and more systematic than the screening
What is the benefit of an interview during assessment?
Assessment adds to available information obtained by other sources; helps confirm archival records; helps develop a positive and trusting relationship between client and counselor
Who, besides the client, might a counselor with to interview during assessment?
Family members, teachers,employers and other significant individuals
What is the assessment frequently referred to at many agencies?
Biopsychosocial assessment
What is a structured interview?
An assessment with a prescribed outline, but allows the interviewer to ask probing questions when necessary
What is a benefit of self-administered tests?
Requires little skill among staff
What is required of the client’s during self-administered tests?
Motivation and ability to read.
To what grade level are most self-administered tests written?
Fourth or fifth
When are self-administered tests especially helpful?
When the client has difficulty talking about himself
Why are self-administered tests most helpful with clients who can’t talk about themselves?
It is indirect and less threatening
What benefit do self-administered tests have in regards to reliability?
The tests are less biased because they are not subject to interpretation
What factors must the counselor keep In mind regarding assessment tools?
Their reliability and validity and the limitations of the tools
What must be true of individuals using assessment tools?
They must be fully trained, credentialed, and supervised.
What effect do cultural factors have on selection of interviews?
Need to consider sequencing of questions, vocabulary, and sensitivity to revealing certain aspects of information.
What is important to consider when selecting a translator to use with clients who do not speak English?
Competency of the translator in both languages, and translator’s knowledge of clinical terminology and slang regarding drugs and drug abuse.
What can be useful for conducting assessment with cultures which do not encourage outward expression?
A group or family interview.
What is the function of a risk assessment during the screening and assessment process?
Ensure the client is not experiencing symptoms of toxicity, intoxication, or withdrawal; assess for danger/aggression towards others; assess for risk of self-harm/suicide; and assess for mental health concerns.
According to the AFSP, what percentage of suicides involve alcohol?
30 %
What percentage of people with alcohol dependence die by suicide?
7%
What percentage of people who die by suicide have a diagnosable disorder?
90 %
What percentage of people who die by suicide have struggled with MDD?
60%
What percentage of alcoholics with co-occurring depression die by suicide?
75%
According to the American Psychiatric Association, what are 3 major areas of suicide assessment?
Current presentation of suicidality; history; and risk management.
What is the benefit of using drug testing?
Assist in evaluation and ongoing monitoring.
What types of drug testing are available?
breath analysis; urine; saliva; sweat; blood; and hair
Why are breathalyzers most commonly used?
They are readily available, convenient, and inexpensive.
Over what period of time can urine tests assess for drug use?
Ranges from 1 week to 1 month, depending on the drug.
Over what period of time do saliva tests assess for drug use?
The past day
What is the benefit of sweat tests?
Assesses cumulative drug use over time.
What is the benefit of blood tests vs the drawback?
They are accurate and reliable, but invasive and costly.
What is the benefit of using hair tests?
Looks for drug use over a period of 2-4 months and more sensitive than saliva or urine tests
What is the most widely used, cost effective, and well-researched test for detecting drugs?
Urine tests
What is the drawback of using hair testing?
Does not detect use within the last 8 days and not good for long-term monitoring due to inability to discriminate between previous vs more recent use.
How are sweat tests performed?
A piece of gauze is attached to individual with a tamper proof seal and sweat is collected over a weeks time.
What sort of drugs can create a false positive in urine tests?
decongestants; prescribed amphetamines; poppy seeds
When should a client be referred to another agency?
When the client’s needs lie outside the agency’s ability to provide service.
What are important factors to assess when looking at co-occurring disorders?
chronicity, severity, disability, and the degree of impairment of functioning.
How do alcohol and drugs affect mental health problems?
They may mimic symptoms, disguise symptoms, or exacerbate symptoms.
What is the benefit of using DSM to describe disorders?
Describe to other professionals who are familiar with the DSM
According to the DSM, what are the two major types of SUDs?
Substance use disorder and substance induced disorders
How are substance induced disorders different from co-occurring disorders?
Symptoms are independent from co-occurring disorders and caused only by the substances.
How many levels of care are there for substance use treatment?
Five
What is ASAM treatment level 0.5?
Early Intervention
What is ASAM treatment level 1?
Outpatient Treatment
What is ASAM treatment level 2?
Intensive Outpatient/Partial Hospitalization
What is ASAM treatment level 3?
Residential/Inpatient treatment
What is ASAM treatment level 4?
Medically managed intensive inpatient treatment.
What are the 6 dimensions used to determine ASAM level of care?
acute intoxication/withdrawal potential; biomedical conditions and complications; emotional, behavioral, or cognitive conditions and complications; readiness to change; relapse continued use or continued problem potential; and recovery/living environment.
