Overview of Screening | Addiction Counselor Exam Review

This episode was pre-recorded as part of
a live continuing education webinar on demand. CEUs are still available for this
presentation through ALLCEUs. Register at Hi everybody and welcome to your review
of the Process of Screening. In this presentation we’re going to review key
skills for engagement discuss factors impacting engagement define screening
explore how to do a screening and identify types of screening instruments
now screening is one of those steps that a lot of people will do especially as a
job an entry-level job in mental health if you’re working towards your hours for
certification or licensure as an addiction counselor you’re probably
going to be in a position at some point where you’re doing a fair amount of
screening so let’s learn how to do that the first step in screening and
assessment and even counseling is developing engagement and engagement
means that you need to develop verbal and nonverbal skills to establish
rapport and promote engagement so how do you establish rapport how do you connect
with somebody when they walk in the office do you sit down with a clipboard
and start writing right away no you want to be able to be open to be warm to make
eye contact to respond to them in a culturally appropriate and culturally
sensitive way so you know you got to be aware of the people that you’re working
with whether you know how much eye contact is enough how much is too much
etc you want to be able to talk to people and you know a lot of people when
they’re coming in for a screening you know may not know what’s going on you
want to be able to put them at ease so hopefully you know those are the skills
that you already have which is one of the reasons that you’re getting involved
in this field but screening means you know first and foremost developing that
relationship because the quality of the relationship with you is going to
determine in many cases whether somebody goes on for the assessment and treatment
if needed you want to discuss with the clients the rationale purpose and
procedures associated with screening an assessment so sit them down and say you
know we’re going to do a screening for substance use so we’re going to do a
screening for depression this is why we do it you know because we know that
whatever percentage of people in this area struggle with depression and that
early intervention is a whole lot more effective than late intervention so the
earlier we can help people arrest the problem then the better off they’re
gonna be and this is what a screening is gonna be you know so they know if
they’re gonna get they’re not gonna get their blood drawn they know you’re just
gonna sit there you’re gonna ask them five or six questions and they’re gonna
be done because they may be thinking that you know they need to lay on the
couch and tell you their deepest darkest secrets and they’re not ready to do that
well of course not they just met you so let them know this is what screening is
assess clients immediate needs including detoxification if you’re meeting with
somebody and you know you notice that they’re under the influence of
substances then they may need detoxification if you’re assessing them
for substance use or substance use disorders and they admit that they have
been using consistently or they’re under the influence they may need detox
administer evidence-based screening and assessment instruments to determine
clients strengths and needs and we’re going to talk about some of those
evidence-based instruments later but you know you can use the cage you can use
the Sassi you can use a variety of different instruments obtain a relevant
history to establish eligibility and appropriateness of services wherever you
are you know you probably accept some insurance don’t accept others you may
have private pay you may not we want to make sure that once we scream we can get
the person into services that they may need you know so we need to determine
where can they go you know if they’ve got Medicaid if their private pay if
they’ve got private insurance you know where could where’s the best referral
place for them and in order to do that we need to get that relevant history
other things that affect eligibility appropriateness for certain treatment
programs some treatment programs will work with people who are on
benzodiazepines others won’t some treatment programs will work with people
who have co-occurring mental health disorders
there’s won’t so this history is important to figure out does this person
need a specialized program are they dealing with specialized issues like
LGBTQ issues are they if they’re an adolescent obviously they’re going to
need an adolescent program so we need to get all of this stuff you know when
we’re doing the screening we’re going to get a little demographic data there and
we’re going to do the screening screen for physical needs medical conditions
and co-occurring mental health issues so while a screening for substance use may
be five questions a full screening is probably going to take 20 or 30 minutes
so we’re going to ask them a variety of questions we’re not gonna get super
in-depth but we are going to get sort of an overview of how this person is doing
that way we can look at it and say you know maybe they’ve got medical
conditions that are contributing if we’re screening for depression maybe
they’ve got medical conditions that are contributing to their depression if they
have a substance use disorder you know is are their medical conditions being
made worse by their substance use and if so what do we need to do so we want to
you know screen we want to screen for co-occurring mental health issues it
does not really matter if the person had depression or anxiety or bipolar before
they started using or they develop depression or anxiety after they started
using right now they’re if they have depression or anxiety it needs to be
addressed because you can’t have somebody sober up and still feel
miserable and expecting to stay sober for long
likewise you know you can’t just treat their mental health issue and expect the
substance use just to go oh so if they if you’re screening for one is really
important to screen for the other substance use will monkey with the
neurotransmitters that can contribute to depression and anxiety so you know
they’ve got substance use we want to screen for that mental health issues
sometimes people will self medicate to try to numb the pain of mental health
issues so again always screen for both of them because the likelihood is if
one exists the other exists at some level as well
interpret results of the screening and assessment and integrate information to
formulate a diagnostic impression and determine the appropriate course of
action so you’re not doing a full diagnosis but you’re gonna go through
and you’re gonna look at the screening results and say yep you know technically
this person meets the criteria for substance use disorder so we need to
send them on for an assessment to see what may need to be done and what our
options are to help them deal with it if you’re screening for depression the same
things gonna be true this person meets the criteria you know we suspect that
they may have major depressive disorder so let’s refer them for an assessment so
we can figure out what’s causing the depression and what options we have for
helping the person deal with it we want to develop a written integrated summary
to support our diagnostic impressions and you’re going to do more of that with
assessment but in the screening you know the Assessors gonna want to know why did
you send this person so you’re gonna present a summary of the information
that you gathered that told you that this person may need to be assessed for
or for substance abuse or mental health issues you know it doesn’t have to be a
dissertation it can be a paragraph but you do want to kind of put it all
together in a nice little package so the Assessor doesn’t have to go back and
read through everything and try to figure out what you saw establish
rapport and an effective working alliance in which the client feels heard
and understood you know be respectful make eye contact smile you know don’t go
directly to your paperwork and make them feel like a number
be punctual that’s really important non-judgmental if they’re talking about
their substance use don’t act shocked like oh my gosh I can’t believe that you
drank while you were pregnant or oh my gosh I can’t believe that you’re using
that much of that substance or you did that
in order to get your drugs no they did what they did to survive they did what
they did to survive given the tools that they had
at that point in time we weren’t in their shoes you know they’re by but the
grace of God goes I so we want to remember that people did what they had
to do and it got them here and it helped them survive until now and we want to be
attentive if we see that the person starts moving around in their seat a
little bit you know ask them you know are you uncomfortable is there something
I can do to make you comfortable they may be uncomfortable about what you’re
talking about they may be you may be running late and
you know you’ve been in the session for 30 minutes and they need to go or they
may need to go to the bathroom or they may be thirsty or cold you know if you
see them starting to become a little bit fidgety and not necessarily even
agitated ask them you know it seems like you’re becoming a little bit anxious or
something I’m wondering if there’s something you need something I can do to
help that will go a long way to helping them feel like you care about them
motivate and engage the client and identified service needs so if you
determine that they need an assessment you’re gonna have to motivate them to go
so help them see how going to an assessment could be beneficial to them
how it help could help them meet their life goals engagement puts the clinician
in the best position to negotiate with the client about what to do and how to
do it so assessment is usually done at whatever treatment center that you’re
hoping the person is going to be enrolled in so we want to talk with them
during the screening about what is it what type of Center do you want to go to
is there a place that you have in mind are there particular characteristics of
treatment that you’re hoping to experience or likewise not experience
some people don’t want to be in a hospital type environment or whatever so
start talking with them about what their options are and negotiate with them you
know if you think they need an assessment and it’s likely that you’re
gonna need to go to residential you know you might want to start moving them
toward the four or five options that offer that service
and encourage them to go and if they don’t think they have a problem they may
not be willing to go yet if they think they’ve got a problem make sure that the
handoff goes really well to that agency if it’s not within your same agency make
sure that that referral goes really well and that they are received equally
warmly by the Assessor at that agency help them feel comfortable going to do
this if you give them a referral and just say here go to this place and
they’ll take care of you the person may be like I don’t know where it is I don’t
know who this person is if you hand them this and say you know go down to this
place and do you know how to get there so let me draw you a map
and that help them know how to get there and then you’re gonna meet with Jane at
this facility and she’s gonna do your assessment I’ve worked with Jane for
years she’s really awesome you know she’ll take her time listening to what
you have to say and what your wants are she’s not going to force you into
anything you don’t want that goes a whole further to motivating the client
to go because they’re not apprehensive about what in the world am i walking
into engaged clients are more likely to participate willingly be treatment
compliant and successfully complete treatment now engagement doesn’t stop
when they leave the screening that’s just the beginning
but you are the face of the mental health system so to speak because you’re
the first person that they interface with so you kind of set the tone for
their experience most of the time create a welcoming environment that’s pleasant
and sensitive to age if you’re working with kids don’t have a sterile
environment with only big people chairs you know have little people chairs and
have you know books that are appropriate if it’s have it be sensitive to gender
you know men aren’t gonna be wanting to sit in an office that everything is pink
and frilly and whatever likewise adults aren’t going to want to sit in a
playroom to do counseling so you know make sure you’ve got age-appropriate
stuff in the room that you’re working working with make it sensitive to
disobey ability if people have hearing
disabilities you know make sure that you can talk loudly enough that they can
hear you make sure you minimize extraneous noise that may keep them from
hearing you make sure the area is compliant with the Americans with
Disabilities Act so people who are physically disabled can get through
doorways and things like that the physical environment should be sensitive
to sexual orientation so have little clues around that you are accepting of
the LGBTQ lifestyle so a rainbow flag on your desk or something it doesn’t have
to be huge you know just little things in the environment that say hey you know
I’m cool with whoever you are cuz you’re an awesome person same thing with
religion you know try to make sure the assessment environment is friendly and
not necessarily oppressively religious you know if you have you know across
here or prayer there or something you know that’s fine that’s your expression
of who you are but we want to make sure that people who are of a different
religion or who are atheist don’t feel oppressed in that environment likewise
people who’ve been traumatized potentially through their church in some
way or another that may be off-putting if they see that
so be cognizant of the things that seem benign to you and what they may mean to
the people who are coming in for screenings and make sure your
environment is sensitive to socioeconomic status and what I mean by
that is you know have a pleasant environment for everybody but people who
are from a higher socioeconomic status for example are probably going to affect
expect a plusher environment and a much different experience more concierge type
services than somebody who is of a middle class or lower socioeconomic
status now does that mean you can just throw folding chairs out for other
people no we want to make sure everybody is comfortable and they feel kind of
like it’s their living room you know we don’t want them to feel like it’s a
stair scary environment but you do need to pay
attention to what is this person or what are the people in my community expecting
when they come in factors impacting engagement can include stigma about the
diagnosis or even about help seeking not everybody is cool with counseling some
cultures say you know counseling bring shame on the family some you know older
people like my grandmother’s age back then and in the 1940s and 50s you didn’t
tell other people your stuff so be conscious of the fact that just being
there may be really overwhelming for people people’s expectations about the
effectiveness of treatment can impact their engagement if they’ve been in
treatment before or they’ve known somebody who’s been in treatment before
and it just never seems to work then they may be there because they have to
be for some reason but they really don’t expect you to be able to help them so
their engagements going to be low one of the things you can do with those people
is make sure you have some tools in your toolbox that are brief interventions
that can help them start feeling better today you know tomorrow something like
that so talk with them sleep is one of the
first and easiest things to start addressing you know talk with them about
their sleep hygiene patterns you know if because people’s inability to relax can
contribute to depression and anxiety and a whole bunch of other stuff so learn
about sleep hygiene and how to create a good sleep routine and encourage them to
start doing that or encourage them to make a list of the people and things
that are important to them so they can figure out where they’re going from here
and they can figure out why they’re doing all this so find a couple of tools
that you can give people so they can focus on the fact that yeah this might
actually help me and it might actually help me move towards my goals and oh by
the way I’m starting to figure out what my goals are people may have
expectations about their role or power in the treatment process so we want to
make sure that clients understand that they are in charge they are in charge of
their treatment make them you know unless I have to do
an involuntary commitment but that’s something a therapist is going to do or
psychiatrist but 99.99% of the time you want to work with the client and they’re
going to be the ones to tell you what’s worked in the past what hasn’t worked in
the past what’s working right now even a little bit and you’re going to talk
about ways to enhance that you know we’re not gonna force them to do things
that they don’t want to do and they may have certain expectations about
treatment itself so we want to dispel any myths about what treatment is like
we want to help them know what our facility or the facility we’re referring
to can provide in terms of treatment and we also want to just help them
understand what to expect so they’re not apprehensive and you’re likeable nests
I hate to say it but you are likeable nough sand they’re likable nesara in
pact engagement if somebody comes into your office and you’re doing a screening
and they are just they have no social skills they’re not attentive they’re not
attractive they’re not happy they’re just mean and cantankerous it’s gonna be
hard to engage them and it’s going to take an extra effort on your part to try
to hear where they’re coming from and hear what’s important to them and form a
bond so the client social skills will impact engagement if they don’t have
great social skills you know you got to work with it and you know if they’re I
had one client that bless his heart he was in college and he would still pick
his nose and eat it and you know I had a hard time focusing when he was doing
that so you know I got to the point where he would do it and as soon as he
pick his nose I pick up a tissue and hand it to him and go here you go looks
like you need that but those are things that you can run into when you are
working with clients and you need to keep that from causing a barrier in your
ability to engage with them if they’re not attentive ask them why you know or
try to look for reasons why they’re not attentive
you know you seem to be kind of distracted is there something I can do
to make you more comfortable and you know it’s just human nature
that we tend to be more engaged with people who are attractive
not everybody’s attractive so you know focus on what the person has to say and
what their heart has to say in order to engage and you know likewise you may not
be write off the pages of Vogue either but try to present yourself well try to
you know dress appropriately don’t show up all disheveled and smelly clothes
like looking like you haven’t bathed in a week that that’s not helpful
so making sure that you’re presenting your best face and you’re dealing with
whatever face the client brings and still trying to build that engagement
remember the way a client presents themself tells us a lot about what’s
contributing to their presenting issues poor social skills ADHD pain you know
there are a variety of things that can contribute to depression anxiety and
substance use so try to look at it from that way even if it’s not your ideal
client understand what’s causing this person to be negative and just
argumentative and frustrating try to get under there and figure out why is this
person so unhappy what’s motivating that first impressions impact engagement so
your professional presentation being prompt being courteous and smooth
handling of paperwork if you walk in there with 15 sheets of paper and you’re
shuffling them around and it seems like you don’t know what you’re doing you’re
like just a second I know I had that form around here somewhere they’re not
going to feel very confident in anything you have to say so put on a good first
impression put it together make sure your paperwork is put together ahead of
time if you have an electronic medical record make sure you know how to use it
because it’s disturbing to people even though it happens when you’re using a
electronic medical health record to do a screening and you
get stuck and you’ve got to call somebody else in to help you figure out
how to get on the next screen make sure the environment is calm clean and
comfortable not too formal or informal like we talked about it avoids
interruptions and provides the appropriate level of privacy
you don’t want clients sitting in the waiting room being able to hear other
clients that are in the therapy rooms or the screening rooms if you’re doing
screenings you may not even be in an office you may be out at a festival or
something so make sure that you’ve got you know little pull around screens or
something if appropriate in order to give people privacy other other people
shouldn’t be hearing their responses to what you are asking them even if it’s
you know like I said even if it’s at a workplace festival or something other
other people should not hear their answers so how can you give them privacy
if there’s no way to do that where they can have auditory privacy put as much as
possible on check sheets and forms that they can fill out and then you can point
to something and go so help me understand your answer to this right
here most of the time you really want to try to do screening in a private room in
the initial interview you’re developing trust and rapport so be empathetic
they’re nervous probably or they don’t want to be there or maybe they do want
to be there and they’re just hoping that you can help paraphrase that to them
whatever vibe you’re getting off of them paraphrase that and work with it convey
warmth and respect and explore the clients strengths and skills you know
you’ve been dealing with this depression or this addiction for a really long time
I’m wondering how you’ve survived until now what has helped you deal with it and
keep on keeping on facilitate the clients understanding of the rationale
purpose and procedures of the screening and assessment explore the clients
problems and expectations regarding treatment and recovery and determine
whether a further assessment is needed that’s your screening so the definition
of screening is the process by which the counselor client and significant others
when possible review the current situation symptoms and collateral
information to determine the probability of a problem so we’re gonna sit down and
we’re gonna go okay what brings you here today what makes you think you got a
problem you know and then we’re going to start asking questions or using
instruments to try to determine whether we think that there’s a probability that
that problem exists screaming is used by all types of Human
Service personnel to determine eligibility and appropriateness of
services and needed referrals so it may be used by a physician by a nurse by a
counselor by a caseworker in order to determine how can we best help this
person achieve their goals and their maximum quality of life it’s not unusual
for caseworkers at Department of Children and Families if people are
coming in to get their their food stamps or EBT that month or they’re enrolling
in the process to do a screening to determine how can we best help this
person you know be able to start earning more money you know maybe they just need
a better job or maybe they’re not able to maintain employment because their
depression is so oppressive so you can see where screening may be used in a lot
of different systems and situations in order to help people figure out how to
help their customers screening determines the immediacy of need you
know you could be doing a screening with somebody who’s like on the fence or they
don’t think they’ve got a problem and it you know their or their problem is minor
so the immediacy may not be great or you could be screening somebody who is you
know heavily intoxicated was just kicked out of his house is facing three DUIs
you know they have a much more immediate need for their personal safety as well
as hopefully they’re more motivated screening needs to be a trance
process we don’t want to sit there with a clipboard and be asking questions and
scribbling things down and going uh-huh uh-huh
well I think you need to go for an assessment that’s not transparent the
clients like where did you come up with that from I usually use screening
instruments and I talk with people and when I’m writing things down I tell them
at the end if you want to see anything I wrote down I would encourage you to you
know I don’t write well i’ve got poor penmanship but i encourage you to read
what I wrote and we’re going to talk about these instruments after you take
them so you know you know why were we asking these particular questions what
does it mean to me as a therapist doing your screening so they understand how
you’re arriving at your conclusions screening does require informed consent
you know it doesn’t have to be a big thing but it does have to happen before
you start screening somebody you need to go you know I’d really like to screen
you for depression or anxiety or this is a wellness screening that your agency is
offered but have them ideally have them sign a sheet acknowledging that they
know that they’re being screened for whatever and screening identifies early
warning signs and helps provide early intervention services and resources so
you know think about high blood pressure or diabetes or any of those physical
things doctor screen for that regularly and if they see that there might be a
problem creeping in they can do something right then to keep it from
becoming a full-blown problem mental health screening is the same we notice
people are under a lot of stress we know that that’s probably going to wear them
out after a while and it might lead to depression so we can start helping them
develop stress management skills for example they may not need to go to
treatment maybe they need to go to psychoeducation and learn about stress
management or maybe you’ve got a book you can let them read or something but
screening is a method of determining what the person needs screening is the
first opportunity to engage the client in the therapeutic relationship and
treatment process sometimes based on observations or other
circumstances people may be referred directly for assessment for example if
people come into the detoxification unit we kind of bypass screening we know
there’s a problem and jump straight into assessment so screening doesn’t always
happen but a lot of times it does because that referral source you know if
you’re an Assessor that person came from somewhere you know their lawyer could
have screened them their doctor could have screened them whatever but somebody
along the way probably screen them to determine yeah you probably need to go
over to this facility and talk to an Assessor the clients internal motivation
is the primary reason for engaging in treatment so if they’re there because
their wife told them they had to be or their boss or the courts that got them
there but to get them actually engaged in treatment and not just going through
the motions they have to have internal motivation there has to be something in
it for them and that’s what we want to work on developing throughout the whole
process help them see how this benefits them what’s in it for them how can it
help them accomplish and get closer to their goals for their life internal
motivation may be fleeting so rapid engagement is vital if you see a spark
of interest or a spark of willingness we kind of need to pounce on that spark and
go alright it seems like you know you really want to get on with this because
you’re sick and tired of being sick and tired so let’s get you enrolled now if
you have to make an appointment for an assessment that’s six weeks out you may
lose the person you know that engagement doesn’t last for long
the engagement lasts while they’re in your office and then you know you got to
have somebody else pick it up and keep that momentum going screening should be
brief you know twenty thirty minutes you don’t want to have somebody in there for
three hours that’s the assessment conducted in a variety of settings by a
range of professionals on persons deemed to be at risk some things we do
Universal screenings for like domestic violence other things you
may do selected screenings for and it also depends on your setting and all
that kind of thing but the take-home point is that screenings are conducted
in a variety of settings whether it be a Health Fair at an employer’s a doctor’s
office sometimes churches will even set up
wellness days and do screenings screening represents the first part of a
collaboration among the multidisciplinary team because the
screener is going to say okay I think I’ve identified that this person
probably has an issue with this and needs to be referred to assessment over
here but they also need help with housing and food and affording their
prescriptions so the screener will kind of link them to other team members in
the multidisciplinary team screening needs to be sensitive to racial cultural
socio-economic and gender related concerns so make sure that you’re
culturally responsive and it needs to be developed from information gathered from
multiple sources when possible when you’re doing a screening a lot of times
the only person you’ve got to do the screening with is the person sitting
right in front of you but if you’ve got other information when I do screenings
on people in the criminal justice system I want to see their criminal record you
know that gives me some objective information on you know how many times
have they been caught DUI whether or not they’ve been convicted how many times
have they been caught DUI and that gives me a little bit more information than
just what that person is telling me if they’ve been involved with the
Department of Children and Families I want them to bring their case report
especially if they’ve got an open case going on screening assesses signs and
symptoms of intoxication and withdrawal three key elements we want to verify
that the behavior deviates from the norm rule out all non drug related causes so
if somebody is having difficulty focusing or they’re
agitated we want to rule out ADHD and schizophrenia and and some other things
that might cause that in order to rule in if you will
stimulant abuse for example so you want to verify that there this is not how
they normally behave you know some people are agitated and a little bit
more bouncy or fidgety or whatever you want to say most of the time if that’s
how they are then you know that’s how they are and it’s not a drug want to
rule out the drug related causes including physical causes you know if
they’re in chronic pain if you know etc there are a lot of reasons somebody
could be excessively sleepy have difficulty concentrating be overly
agitated there are a lot of things use diagnostic procedures to determine the
types of drugs being used so in a screening we’re gonna ask them what
they’ve been using but ideally you can also do an on-site drug screening you
know having pee in a cup and the on-site screenings are not super reliable but it
gives you something to look at you know most cases it’s anywhere between 60 and
70 percent reliability which is why if it comes up positive and the person says
I didn’t use that it needs to be sent off to a lab for mass spectrometry in
order to determine what happened because you can get false positives and you can
get false negatives so they may have used something and it doesn’t show up on
the test so you don’t want to just trust the on sites as being a hundred percent
but it is a good tool to identify whether the person is telling you the
truth about how much or what their current whether they’re currently using
or not assess clients mental health and trauma history you’re not gonna get deep
into the weeds here just ask them if they have a history of depression
anxiety abuse of any sort and move on their safety or an environmental needs
do they have a safe place to sleep you know if they have a address you know do
they feel safe in their home do they eat well how’s their nutrition
do they have any physical health needs that are not getting met do they have
any other wraparound needs if they’ve got kids do they have access to child
care are they having problems with transportation are they able to afford
their medications that they’re already prescribed etc so we want to ask them
about some basic things like that and then we’re going to assess danger to
their themselves and others are they talking about harming themselves or
someone else and we also want to ask if they’re thinking about hurting
themselves or someone else screening methods include interviewing the clients
and significant others using screening instruments and lab tests like
urinalysis that we talked about signs of substance use disorders or mental health
issues we want to look for number one the circumstances of contact if the
person was referred by the court then that’s a pretty good sign that there’s
may be a substance use disorder going on if they’re referred because of a DUI for
example if they’re referred because of a fight they got into but they weren’t
using at the time their blood alcohol was zero zero we want to look maybe for
mental health issues and things like intermittent explosive disorder you want
to look at the clients demeanor and behavior are they acting like they’re
under the influence when they come in for the screening are they showing signs
of acute intoxication or withdrawal are there any physical signs of drug use or
self-injury needle injection marks if they have a get frequent bloody noses
you know if they get bloody noses while they’re in your office or if they have
signs that they’ve been picking those can be all physical signs of drug use
emaciation and malnutrition also signs some drugs will cause the pupils to be
really dilated other drugs will cause the pupils to be pinpoint so you want to
know what the signs of different drugs are for drugs of intoxication and
different signs that people have been using
especially injection but like I said sometimes drugs will cause people to
pick or itch and that will show indicate to you that there might be an underlying
issue and information spontaneously offered by the client or significant
others can give you information about whether there’s a substance use or
mental health issue and sometimes the significant other let me just kind of
back up there may be the significant the spouse brought the person in and when
you go out to meet them you the person the person being interviewed doesn’t
really want their spouse in there they want they want to go back by themselves
okay that’s cool you go out and meet the person and then if you can with
permission bring the spouse back after the
screening to give them both the results and at that point the significant other
the spouse may spontaneously say oh well why didn’t you tell them about you know
the DUI you had three years ago or whatever
so sometimes spouses will just kind of blurt things out because they suspect
that the significant other didn’t already say it during the interview so
if you can get that person in a private place where they have an opportunity to
say something that’s wonderful but remember you know you do have to
have the clients permission screening instruments can be developed by the
agency or use standardized instruments the cage is a really common one and you
ask a person have they tried to cut down unsuccessfully
do they feel annoyed when people talk to them about their substance use do they
feel guilty about the substances about using their substances and do they
sometimes have to use first thing in the morning to kind of wake up we call it an
eye-opener if they say yes to one or more of those there’s a chance that they
may have a problem the gain is another tool that you can use as is the Michigan
alcohol screening test or the Sasi so all of those are standardized
instruments some of them cost money others like the Kay
don’t so it may depend on your agency and what kind of budget you’ve got what
instruments you’re using any instruments you do use must clearly detail what
action should be taken based on received scores so if a person takes the cage and
they say yes to one but not any of the others does that mean they should be
sent for a referral if they say yes to two when at what point should they be
sent for a full assessment you want to screen when screening for mental health
you want to screen for acute symptoms such as hallucinations delusions or
depression or anxiety suicidal thoughts and behaviors and other mood and thought
disturbances so you’re gonna ask them about time place purpose and person do
you know what time it is do you know where you are do you know why you’re
here and do you know who I am and you’re gonna ask them about short and long term
memory if they can tell you about something from their childhood great but
you’re also going to ask them if they can tell you about what they had for
lunch another thing you want to assess or
another way to assess short-term memory is to tell them I’m gonna tell you four
words and I want I’m gonna ask you in a few minutes to recall those four words
for me and then tell them four words make them easy words like dog cat bird
and fish you know not something that’s hard to remember and then in five or ten
minutes ask them what were the four words I told
you and see if they can remember you’re gonna ask them about prior involvement
in mental health treatment what worked what didn’t if they have been in
treatment what prescription medications do they use and this includes all
prescriptions because physical health prescriptions can have mental health
side effects ask them about recent traumas again
don’t get into it but ask them if they’ve been victimized or experienced
any sort of abuse and a family history of mental illness if they have a family
history of mental illness the chances of them developing mental illness are a
little bit greater when screening for mental health you’re going to use the
modified mini screen the Mental Status exam the mini Mental Status exam the
brief symptom inventory a brief psychiatric rating scale or the symptom
checklist 9 t/r so those are the ones that you’re typically going to use a lot
of times they’re already in your electronic medical record so you’re not
going to have to figure out what to use in terms of you know knowing what the
instruments are for certification and testing purposes these are the six that
you want to be aware of so you can google each one of them and find out
more about what each screening test can provide you screening is the initial
contact to decide if a person may need a more in-depth assessment screening is
brief but requires the person to be engaged in the process in order to get
an accurate result how well the person is engaged in the screening process is a
direct predictor of whether he or she will continue in the process if you enjoy this podcast please like
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