week 4: screening and assessment tools Flashcards
what is screening and assessments? the difference?
Screening tools are designed to identify those who are potentially experiencing a substance use problem. An abnormal or positive screening result may “raise suspicion” about the presence of a problem, while a normal or negative result should suggest a low probability of a problem. In contrast, assessment tools are designed to explore fully the nature and extent of a person’s substance use problem. Such assessment information can be used to determine whether the person meets the criteria for a particular diagnostic category, such as alcohol use disorder, depending on the system being applied (see diagnostic tools from Topic 1). Both screening and assessment tools are integral in the process to establish appropriate treatments for a service use.
what is one of the popular screening tools?
-the Audit is widely used
what are the The four central questions that need to be considered in selecting a screening tool are:
the goals of the screening
The characteristics of the measure for the target population
The time and resources available for conducting the screening
The resources available for scoring the screening measure and providing feedback/referral for positive cases
in 2009 the National Health and Medical Research Council produced the below guidelines for the safe consumption of Alcohol in Australia, what are they?
Reducing the risk of alcohol-related harm over a lifetime
Drinking no more than 2 standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.
Reducing the risk of injury on a single occasion of drinking
Drinking no more than 4 standard drinks on a single occasion reduces the risk of alcohol related injury arising from that occasion.
Children and young people under 18 years of age
For children and young people under 18 years of age, not drinking alcohol is the safest option.
Pregnancy and breastfeeding
Maternal alcohol consumption can harm the developing foetus or breastfeeding baby.
what is a standard drink?
10 grams of alcohol. Beer, wine and spirits vary in the amount of alcohol they contain. The easiest way to estimate how many standard drinks you consume is to look at the drink container, most of which state their alcoholic content.
what are the most widely used self reported screening test for alcohol?
The Alcohol Use Disorders Identification Test (AUDIT) is the preferred screening tool used in Australia, UK and Europe (Babor, Higgins-Biddle, Saunders & Monteiro, 2001; Reinert & Allen, 2007).
The Michigan Alcoholism Screening Test (MAST) was developed in North America. It has been widely used and there is considerable information on the test’s psychometric properties (Dawe & Mattick, 1997).
The TWEAK, was developed specifically for the purpose of screening for hazardous drinking in pregnant women. The TWEAK, though, is now being validated for use with men and women in the general population (Jones, 2011).
Quantity-Frequency methods of alcohol intake can be measured directly by asking a client how much they drink (quantity) and how often they drink (frequency). There are many ways in which quantity and frequency information has been obtained (see Room, 1990, for a review). The most commonly used method in surveys of drinking patterns was developed in the late 1960’s by Cahalan and colleagues (Cahalan, Cisin & Crossley, 1967). While quick and easy to administer, Quantity-Frequency methods generally do not provide information on atypical drinking periods but assume that drinkers’ consumption patterns are stable. They are likely to be less accurate when substantial fluctuations in use are present.
The Khavari Alcohol Test offers a quick method of estimating the overall quantity of alcohol consumed over a specific time period, including periods of very heavy drinking. However, it does not determine the pattern of drinking.
The use of biochemical measures as either screening or diagnostic tools have been the focus of considerable attention in the alcohol field. However, they pose relatively limited value in detecting an alcohol use disorder. Traditionally used measures of liver function, routinely used as indicators of excessive drinking, generally lack sensitivity in detecting hazardous alcohol use. More specific measures of alcohol use such as carbohydrate-deficient transferring (CDT) are more specific to detecting alcohol misuse than liver function tests, but still tend to be less sensitive to alcohol misuse than self-report questionnaires.
Although there are many techniques and instruments for assessing and measuring alcohol misuse, ultimately, as Sobell and Sobell (1995, p. 55) note, “the utility of a drinking measure for research and/or clinical purposes will rest on its intended use”.
Turning Point Online Screening Tool
In 2012, Turning Point developed a new AOD screening and assessment tool commissioned by the Victorian Department of Health. The new tool is evidence-based and available as a face-to-face tool for use by clinicians and clients attending AOD or health and community services
An online modified version for self-completion by clients provides immediate individualised feedback on severity of reported AOD use and links to additional support.
Feedback on the use of the online tool is provided below
contrary to expectations, online help-seekers were not dominated by young people, but rather covered a range of ages similar to face-to-face help-seekers
some overlap between help-seeking populations but also significant differences
in general, face-to-face help-seekers had greater problem severity and more life complexities than online help-seekers
there is an opportunity for early engagement of a new population of substance users, many of whom would likely benefit from brief intervention
a more flexible model of treatment and support is needed for those unable or unwilling to access face-to-face services or who could be effectively treated with online and/or brief interventions
what are some Problematic drug use screening tools
The Australian Guideline for Treatment of Problem Gambling (Thomas et al., 2011) recommends adults with a high risk of mental health problems could be screened and assessed for problem gambling using a validated screening tool. In Australia the PGSI has been adopted as the preferred screening tool to measure problem gambling severity.
what is the main screening tool for gambling?
here are a range of screening tools for problematic gambling (see Table 2 below). The Australian Guideline for Treatment of Problem Gambling (Thomas et al., 2011) recommends adults with a high risk of mental health problems could be screened and assessed for problem gambling using a validated screening tool. In Australia the PGSI has been adopted as the preferred screening tool to measure problem gambling severity.
The gold standard for determining a pathological gambling problem is a clinically administered DSM interview. This however does not generally occur in the treatment setting – most clinicians use a semi structured interview approach and possibly an assessment or screening tool.
when a problem has been indicated though the screening process, what then happens with the assessment?
After screening has established problematic substance use or gambling, a comprehensive assessment is required to inform diagnosis and treatment planning. This ongoing process involves making an assessment of an individual’s presenting issue/s, their background and personal history, substance use and/or gambling history (including current use), motivation and readiness to change current issues, and screening for comorbid issues (NSW Health).
The therapist collects information informally in conversation with an individual and, when appropriate, their significant others, and formally via structured interview, test reports, referrals and information provided by other health professionals with whom an individual is engaged. Consulting multiple sources of information assists the therapist to gain an accurate picture of an individual’s presenting condition, and is particularly important if an individual is intoxicated, has difficulty remembering details, and/or is experiencing memory or functioning impairment
what does a clinical interview involve?
- history of drugs
- pattern of use quantity, duration, last use, cost, injecting, snorting etc. what is their most problematic drug
- why are they using it? what are the effects they are trying to get? is it to cope with anxiety, numb pain, peer pressure
- what are the concequences?
- determine if they are dependent
- mental health history and family members
- how many times they have seeked treatment
- what risk are they/are they risk to others
purposes of alcohol/drug use mean?
- what are people trying to get from the drug.
- financial problems from the drug
- what is their peer situation, are they around other people that are using?
- dependence
motivations for alcohol/drug use mean?
-how interested are you in chancing your substance use?
-whats going to help you?
- how confident are that you can change?
this give a sense of where the person is in terms of their motivation.
what does the assessment of frequency involve?
many different methods,
- can just ask people
- or can use timeline follow back, get calendar and could back to what they consumed
what does assessing risk in the assessment involve?
- is the person at risk, are they still using?
- do they have young children?
- if they stop are they going to go into withdrawal?
- if they are still using and are out of control, what risk are they in terms of other risk such as drink driving, violence, sexual behaviours
- psychosocial, family violence, young children, impact on society
why might you screen for Acquired Brain Injury (ABI)?
- people had accidents maybe due to the drug use
- or maybe are disoriented or impaired just from using the drugs
