Assessment
abilities, preferences and barriers (assessment)
Abilities—what they cant and can do Preferences- extremely important, consumer driven, consumers have choices now. Whats your preferred language for treatment? Find out what barriers does the client has (weaknesses) that will either prevent them from treatment or achieving their goals and objectives (transportation, single parent with three kids "child care") we have to try to reduce the barriers as much as we can to increase the objectives of treatment
GAIN Quick (GAIN-Q or 3)
Administration Time: 20-30 minutes Purpose: Designed for use in targeted populations to support brief intervention or referral for further assessment or behavioral intervention ~~~ Id problem areas, Justify level of care Mini-intake tool. Provides enough info to identify problem areas and justify the levels of care.
GAIN Short Screen (GAIN-SS)
Administration Time: 5 minutes Training Requirements: Minimal Purpose: Designed for use in general populations or where there is less control to identify who has a disorder warranting further assessment or behavioral intervention, measuring change in the same, and comparing programs ~~~ Appropriate for outreach Should be used in a outreach type of situation but doesn't provide in depth info.
GAIN Initial (GAIN-I)
Administration Time: Core version 60-90 minutes/Full version 120-160 minutes (depending on severity and inclusion of GPRA module) Purpose: Designed to provide a standardized biopsychosocial for people presenting to a substance abuse treatment using DSM-IV for diagnosis, ASAM for placement, and needing to meet common requirements for assessment, diagnosis, placement, treatment planning, accreditation, performance/outcome monitoring, economic analysis, program planning and to support referral/communications with other systems ~~~ Extremely Comprehensive 113 pages long substance abuse assessment ASAM-treatment recommendations, problems, level of care---now only for adolescence & federal grants In depth, highly comprehensive substance abuse assessment. Problems, areas, treatment recommendation, proper levels of care. 113 pages long. Based on motivational interviewing and it alights with DSM5 it will give proper diagnosis and based on the symptoms the client is giving. We don't need to know the scales but the idea or concept of them
Consider possibility of multiple, interconnected issues
Are the issues interrelated? Connected?
Never rely on single assessment tool
Assessment is basically a number of questions!
Most salient are drugs used in the past 90 days. Diagnosis is about the symptoms, not the drugs used.
Assessments that use a timeline such as this is called a timeline followback assessment. Recommended as it a 90 days makes the timeline more concrete. Find a concrete day with a neutral or positive event attached to it and use the event as an anchor. Do not assume the meaning of the experience. The amount of drinks needs to be placed in the context of time. i.e. 3 drinks in an hour vs. 5 drinks over 10 hours. Make sure to clarify that the present people were also sharing the drink, rather than just being there. Clarification is important. Clarify if the other medications being used are prescription and if they are being taken according with the prescription. If the client is taking more than was prescribed is misuse. We cannot assume that they are not misusing because it is a prescription. Find out who prescribed, how they were told to take it and how they are taking it.
why assessment
Capitalize on strengths & abilities as well as understand their basic needs before treatment If client unemployed & living w/ family barrier to taking medications can be cost, preference can be availability to come in for appointment (time)
Characterize the problem & Guide treatment planning (assessment)
Characterize the problem- we have to understand the case conceptualization. What are the client's mental health symptoms looks like when he is using and not using drugs. We have to understand the whole pictures. How does his/her family understands or sees the problem. How are the problems interact with each other and what are the interventions we choose to use. All these decisions should be based on our assessment. If we don't have a good assessment then we may not have a good treatment plan
Special Issues of Assessment
Confidentiality, validity, reliability and Taping Clinical Interviews
principles of sound assessment
Determine the purpose of assessment Involve the client Ensure instruments demonstrate test trustworthiness Never rely on single assessment tool Consider possibility of multiple, interconnected issues Assess the client's environment Evaluate client strengths Consider alternative hypotheses Consult Provide feedback about assessment results to clients
Diagnose & Provide feedback (assessment)
Diagnose- if you want to get paid you have to have diagnoses for the client and maybe from the first visit! Insurance company will not tell you what they cover. Diagnoses serves the place within our field. We want to provide feedback to the client- there is some short on that. Physicians and psychologist and psychiatrist are good at giving feedback. However, we as counselors are short on that. Feedback is important because counselor can change things to make an impact to the client, or to correct you if you miss something. We are reflecting back to them based on what they told us.
Evaluate client strengths
Evaluate the client's strength not only from our perspective, but also from their perspective. Assess and reassess their strengths.
Confidentiality (issues)
Federal Regulations 42CFR Part II HIPAA (Health Insurance Portability and Accountability Act) Exceptions: Child abuse, emergencies, danger to self or others
methods of assessment
Formal vs. informal Standardized vs. nonstandardized Objective vs. subjective Standardized tests Checklists and rating scales Other inventories Clinical interviews Mental status examination Qualitative methods
Assess the client's environment
How is the environment around the client? Does he has a home? Is it clean? Does he shower? Does he has his basic needs? What do they think of their living situation? We like to assume people are homeless and they are bothered by it. However, not all homeless people are not happy with it. We cannot assume that their concept of homelessness or specific situation is similar to our concept.
Purpose of Assessment
Identify problems Evaluate the severity of the problems Establish risk relationships (co-morbidities) Identify strengths, needs, abilities, and preferences Identify barriers Diagnose Provide feedback Characterize the problem Guide treatment planning
Involve the client
Involve the client by reflection of meaning, feelings, feedback,
measure of use
It is important to define and quantify how much clients mean by a drink. It is not unusual for people to have doubles, or double cans of beer, etc. the client might not mean the same thing as you think by 'a drink' A blunt -> can be anything from 2 to 6 joints. This terminology can be misleading to the therapist. Pills etc are easier to quantify as there is a standard dosage.
the extent of use
Know how much are they using? In the past 90 days (3-months) for example today is oct 8, ask how mandy days did u consume drugs or alcohol since july 8 or july 4 instead the last 90 days What was the most drink you had in one day Over how many hours did you do this With how many people, if any, were you sharing? If alone then It would triggers worries to me
interview format and content
Mental Status Presenting Complaint or problem then ask why today? Why now? To know what triggered them to come Alcohol and Drug Use Effects and Consequences of Substance Use and Abuse Prior Treatment and how it turned out Vocational and education history Medical history Legal Social and Familial support Psychological and Psychiatric history (what does their use looks like when they have mental behaviors or when they don't have mental behavior) Recreational Spiritual Cultural & Acculturation Sexual Abuse History Violence History
Taping Clinical Interviews (issues)
Must get written permission Must give client option to request it be turned off at any time and especially when legal matters are being discussed Must explain how recording will be used Must explain what will happen to the recording
Addiction Severity Index provides
Provides a comprehensive intake assessment Medical Employment/Support Drug Alcohol Legal Family/social Psychiatric Provides clinical information necessary for treatment planning Assists in identifying when to make referrals *ASI---Must supplement it with an additional mental health test ----it is very weak in that area
spiritual practices
Spiritual practices may include meditation, mindfulness, prayer, the contemplation of sacred texts, ethical development, and the use of psychoactive substances (entheogens). Love and/or compassion are often described as the mainstay of spiritual development
Addiction Severity Index assessment
Standardized, semi-structured, multi-focused assessment tool Used to collect information about the nature and severity of problems Clinical, evaluation, and research capability Takes about 45 minutes to administer Asks about lifetime and past 30 days Obtains client rating Obtains clinician rating
Global Appraisal of Individual Needs (GAIN)
The GAIN family of instruments has been developed through a 15 year collaboration of researchers, clinicians, policy makers, and IT specialists
treatment history
The more treatment episodes = the more relapses. A relapse means that the treatment needs to change to meet the client's needs. We need to understand what triggered the relapse and what happened that they weren't able to use the coping skills that they had developed previously. Treatment history includes how intensive the treatment received was. Episode of care involves from admission to discharge from one agency. Outpatient might be office based or home based. If the client has never completed a home based program the barriers might be different (not about transportation, childcare, timing, etc)
structured interview
The questions are asked in a set / standardized order and the interviewer will not deviate from the interview schedule or probe beyond the answers received (so they are not flexible). This means it is easy to test for reliability.
subjective test
The test which is not scored by following strict rules. There is an open choice to score them. These tests are administered to judge a student's abilities that to what extent he/she can comprehend the learnt concept.
consult
There are things that we may not understand so we must consult with another professional.
Ensure instruments demonstrate test trustworthiness
Trustworthy: we want them to have validity and reliability
about 42cfr
We have to be careful with texting, e-mailing or any network! Hippa and confidentiality... the same as what I heave learned... harm to one or other, abuse, Federal regulation over rides state law. It is stricter than hippa. If sopopeana asks to release info we must do so but federal law we cant release substance abuse.. We can only release it by court order. When it comes to abuse, the only stipulation (exception) in 42cfr is child abuse. So if we have an elder getting abuse by his daughter we don't report it but if it is a child then yes we do. Unless this elder is being threated to be killed then we must report because if we don't then it will go against us. 42CFR is more stringent than hippa. In the state of florida, a minor can consign him or her to substance abuse treatment. They cant do that to medical or mental care. Minor is anyone under the age of 18. the rule of thumb is 10 and above. Without consent from this minor, parents will be prohibited from knowing. So minors can co-sign themselves to institution for substance abuse and if they aren't present at home they could be labeled as missing or ran away but parents will not know unless there is co-sign agreement from the minor client. ONLY FOR SUBSTANCE ABUSE. The court can order the client a treatment or residential but the judge cant.
last use
We need to know when was the last time they used drugs or alcohol so that we know what type of drugs they use and how often You are more interested in what happened 3 months ago
Determine the purpose of assessment
What do we want to know from our assessment? What are we assessing for? We have to be focused but we don't want it to be burden to the client. Based on the assessment we can decide whether to go forward. Is the client reporting trauma symptoms? If yes well go forward.
assessing substance use
You might want to ask questions about when was the last time that the client used any drugs. The wording of the question is open and nonjudgmental. "When was the last time, if ever, you used alcohol?" Specify that alcohol includes things such as beer and wine. Time is important. If the last time they used was over 1 year it is not relevant. Getting past the lifetime history of use helps to focus the interview.
culture content
age, gender, sexual orientation, ethnicity, etc....
unstructured interview
an interview in which there is no a specific set of predetermined questions, although the interviewer usually has certain topics in mind that they wish to cover during the interview. Unstructured interviews flow like an everyday conversation, and tend to be more informal and open-ended.
semi-structured interview
an open interview, allowing new ideas to be brought up during the interview as a result of what the interviewee says. The interviewer in a semi-structured interview generally has a framework of themes to be explored or follows a guide, but is able to follow topical trajectories in the conversation that may stray from the guide when he feels this is appropriate.
Assessment
any systematic method of obtaining information from tests and other sources, used to draw inferences about characteristics of people, objects, or programs. Systematic structure that we use to make sense of the behavior that we are doing
An objective test
is a psychological test that measures an individual's characteristics independent of rater bias or the examiner's own beliefs, usually by the administration of a bank of questions marked and compared against exacting scoring mechanisms that are completely standardized
Consider alternative hypotheses
is there any other solutions
Violence includes
perpetrator, suffer/victim, exposure (heard/saw), etc...
Provide feedback about assessment results to clients
run evaluations and discuss results with client
validity (issues)
the extent to which a test measures what it is supposed to measure (accuracy). example, it relates more to structure interview. Is it suppose to measure ADHD?
Reliability
the extent to which an experiment, test, or measuring procedure yields the same results on repeated trials specially if there was no intervention. Information usually is reliable If there is a therapeutic relationship If counselor sets the stage, including how the information will be used If client questions are addressed ~~~~~~ If a test is not reliable then it is not useful. The client has to be comfortable with me to feel engaged. Therapeutic relationship is important. Clients have to know the assessment we are doing on them and why we are doing such assessment. We have to set the stage for them. we have to tell them what we are doing and we have to tell the about sharing the assessments (confidentiality). We have to use transitions during assessment we cant jump from one topic to another. Ask if the client has a question periodically.
types of assessment
unstructured, semi-structured and structured The Clinical Interview is the most commonly used
things to know about treatment plan
you want to know what triggered the relapse, they could not have coping skills or they don't know how to use coping skills. Lack of support, stopped going to the AA meeting for example,
42 CFR Part 2 - CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS
—violating Federal Law if report elderly abuse (state law) Even in case of emergency only necessary life saving info can be provided to paramedics State of Florida can sign themselves up for treatment w/o parental consent, by the law a 3 year old can do it because no consensus on what a minor is. Complicated because if minor is also diagnosed with depression you cannot treat them w/o parental authorization unless in emergency-crisis situations
