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III A.Routine screening methods for mental health symptoms

Element Details

Definition

Programs that provide services to individuals with co-occurring disorders routinely and systematically screen for both substance use and mental health disorders. The following text box provides a standard definition of "screening" and originates from SAMHSA’s Co-Occurring Measure (2007). Source Observation of milieu and physical settings, review of documentation of patient handouts, videos, brochures, posters and materials for clients and families that are available and/or used in groups.

Screening:

The purpose of screening is to determine the likelihood that a person has a co-occurring substance use or mental disorder. The purpose is not to establish the presence or specific type of such a disorder, but to establish the need for an in-depth assessment. Screening is a formal process that typically is brief and occurs soon after the patient presents for services. There are three essential elements that characterize screening: intent, formal process, and early implementation.

  • Intent: Screening is intended to determine the possibility of a co-occurring disorder, not to establish definitively the presence, or absence, or specific type of such a disorder.
  • Formal process: The information gathered during screening is substantially the same no matter who collects it. Although a standardized scale or test need not be used, the same information must be gathered in a consistently applied process and interpreted or used in essentially the same way for everyone screened.
  • Early implementation: Screening is conducted early in a person’s treatment episode. For the purpose of this questionnaire, screening would routinely be conducted within the first four visits or within the first month following admission to treatment.

Source:

Interviews with program leadership and staff, observations of medical record (or electronic medical record system) or intake screening form packets.

Item Response Coding:

Coding of this item requires the evaluation of screening methods routinely used in the program.

  • Addiction Only Services = (SCORE-1): Pre-admission screening based on patient self-report. Decision based on clinician inference from patient presentation or by history. The program has essentially no screening for mental health disorders. On occasion, a program at this level offers a minimal screening for mental health disorders, which is based on the clinician’s initial observations and/or impressions.
  • (SCORE-2): Pre-admission screening for symptom and treatment history, current medications, suicide/homicide history prior to admission. The program conducts a basic screening for mental health problems prior to admission, but it is not a routine or standardized component of the evaluation procedures (occurs less than 80 percent of the time). At this level, the screen might include some symptom review, treatment history, current medications, and/or suicide/homicide history. Considerable variability across clinicians occurs at this level.
  • Dual Diagnosis Capable = (SCORE-3): Routine set of standard interview questions for mental health using generic framework, e.g., ASAM-PPC (Dimension III) or “biopsychosocial” data collection. The program conducts a screening process with interview questions for mental health problems; it is incorporated into a more comprehensive evaluation procedure and it occurs routinely (at least 80 percent of the time). This screening is standardized in that it consists of a standard set of questions or items and a routine mental health status screening, including questions to assess risk of harm to self or others. The format of the screening questions may be open-ended or discrete, but they are used consistently.
  • (SCORE-4): Screen for mental health symptoms using standardized or formal instruments with established psychometric properties. The program conducts a systematic screening process that uses standardized, reliable and valid instrument(s) for screening mental health symptoms. This screening process is routinely used (at least 80 percent of the time).
  • Dual Diagnosis Enhanced = (SCORE-5): Screen using standardized or formal instruments for both mental health and substance use disorders with established psychometric properties. The program conducts a systematic screening process which uses standardized, reliable, and validated instrument(s) for screening both substance use and mental health disorders. This screening process is routinely (at least 80 percent of the time) incorporated into the comprehensive evaluation procedures, and it is considered an essential component in directing the individual’s care.