Screening and Assessment
Individuals who screen positive for co-occurring mental and substance use disorders should receive an indepth, integrated assessment. Integrated assessments gather information and engage individuals in a process that enables the practitioner to establish (or rule out) the presence or absence of a co-occurring disorder.
- Determine the individual's readiness for change
- Identify strengths or problem areas that may affect treatment and recovery
- Engage the individual in the development of a treatment relationship
Assessment is an ongoing process that should be repeated over time to capture the changing nature of the individual's status as he or she moves through recovery.
Effective assessments are a partnership
The goal of an assessment is to gather information to define the nature of that problem. Assessments inform treatment planning and how services are delivered. For this reason, integrated assessments should be conducted in partnership with individuals seeking treatment within the context of a strong therapeutic relationship. Effective assessments are centered on the individual's understanding of his or her problem(s) and his or her goals.
Integrated assessment addresses both mental and substance use disorders, each in the context of the other disorder. There are 12 specific steps in the assessment process. Through these steps, the assessment seeks to:
- Obtain a chronological history of symptoms and treatment for both mental and substance use disorders.
- Obtain a description of current strengths, supports, limitations, and cultural barriers that will impact treatment.
- Find out what the individuals want, what they want to change, and how they think that change will occur.
- Establish formal diagnoses, evaluate level of functioning to understand the impact on treatment, and determine readiness for change.
- Make initial decisions about appropriate care.
Integrated assessments consider:
- Cultural and linguistic issues,
- Amount of social support,
- Special life circumstances (e.g., women with children),
- Medical conditions (e.g., HIV/ AIDS, tuberculosis) that may affect service choices
Assess using multiple approaches
An assessment includes gathering information in many ways. Assessment instruments help practitioners gather standardized information and establish scores that define problem areas. They may also help practitioners remember to cover all relevant areas. There is no single gold standard assessment tool for co-occurring disorders.
Assessment instruments provide information that is one part of the assessment process. They do not themselves constitute an assessment. For example, instruments may not:
- Make the individual feel welcome
- Engage the individual as an active partner in his or her care
- Begin the therapeutic alliance
In addition to the assessment instruments, the assessment process may include:
- A clinical examination of the functioning and well-being of the individual
- An in-depth interview
- A social and treatment history
- Interviews with friends and family (with permission)
- a review of medical and psychiatric records
- a physical examination
- laboratory tests
A diagnosis is established by referral to a psychiatrist, clinical psychologist, or other qualified healthcare professional.
Resources and Links
This guidance takes the reader through all aspects of a COD assessment, including key concepts, domains of an assessment, advice on assessing individuals with COD, and general information about substance abuse and mental health issues.
This chapter describes the 12 steps of the assessment process, including tips for the counselor and case studies.
LOCUS is a COD assessment tool. This LOCUS guidance includes an introduction to the tool, instructions for using the tool, and definitions and utilization criteria.