Screening and Assessment

Integrated Screening

Integrated screening determines the likelihood that an individual has co-occurring substance use and mental disorders. The purpose of screening is not to provide a diagnosis but to establish the need for an indepth assessment. Screening is a brief, formal process that occurs soon after the individual seeks services.

Screening identifies individuals who might have co-occurring disorders

Integrated screening addresses both mental and substance use disorders, each in the context of the other disorder. Integrated screening seeks to answer a yes/no question: "Is there sufficient evidence of a substance use and/or other mental disorder to warrant further exploration?"

Screening expedites entry into appropriate services. A comprehensive screening process can include exploration of a variety of related service needs including medical, housing, victimization, trauma, and so on. The goal is to identify individuals who might have co-occurring disorders and related service needs.

All practitioners can be trained to screen for co-occurring disorders. This screening often includes:

• Having an individual respond to a specific set of questions
• Scoring those questions
• Taking the next "yes" or "no" step in the process

In substance abuse or mental health settings, integrated screening can be conducted as a part of the intake process. Individuals who screen positive may receive an indepth, integrated assessment at the same agency or receive a referral to another agency.

Standardized tools are a helpful part of the process

Screening tools can be an efficient form of information gathering. Advantages include:

• They can be simple to use and score.
• Training needed for their administration is minimal
• Reliability is generally known
• Cut-off scores are available to facilitate decision-making

One disadvantage to using standardized tools is that they provide little opportunity to establish a connection with the individual. Such a connection is an important part of establishing a therapeutic relationship. Standardized tools are more effective when they are one component of a more comprehensive approach.

When selecting appropriate screening tools, it may make sense to form a workgroup to review existing instruments. Of states that have gone through this process, most choose one of the following models:

• Use of a single standardized state-identified screening instrument: Using this model, states identified either one instrument for use across both systems of care, or two separate instruments, one for use within each system.
• Choice from a menu of screening instruments: Some states allowed agencies to choose from a list of identified and approved tools.

Some states have adapted from existing instruments to create their own tools.

A list of popular screening tools and links to them can be found at: http://www.bhevolution.org/public/screening_tools.page

Involve key stakeholders when selecting screening tools

In at least one state in which little initial practitioner input was obtained, the original selection of instruments had to be abandoned and new instruments identified that were more acceptable. One idea is to pilot the instruments and obtain practitioner feedback about the utility and ease of administration.

Specific training on integrated screening and assessment can be offered to practitioners. Training will help to ensure consistent use of standardized tools and full understanding of the screening and assessment process.

Define a protocol for screening

Protocols can help to define the screening and assessment process. Protocols can include "cut-off scores" or what constitutes scoring positive for co-occurring disorders. Protocols also detail what takes place for individuals who score positive. It includes the necessary standard forms to be used to document the results and the completion of each step in the process.

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Resources and Links

• Alaska Screening Tool 2010: Supporting Clinical Decision Making

  A screening tool developed by the State of Alaska has shown high reliability and validity. This report summarizes the tool, how it should be used and scored, and how it supports decision-making.

• Results from the Screening Pilot of the Co-Occurring Disorders Initiative

  A summary report of a pilot project in Connecticut to determine the best COD screening tools. The report reviews the screening tools used, the advantages and disadvantages of each, and the pilot results.

• Screening for the Possibility of Co-occurring Mental Illness and Substance Use Disorder in the Behavioral Health Setting

  Minnesota's report on implementing COD screening tools, including what makes a good screening tool, what screening tools fit their criteria, and how to conduct screenings.