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MAKING THE MOST OF LIMITED RESOURCES
A web presentation for
RSAT - T&TA
by Phillip Barbour
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This presentation addresses the issues
relevant to screening and makes
recommendations for the appropriate use of
screening and tools in specific settings.
Spotlight on Illinois Criminal Justice System
and TASC
http://www.kap.samhsa.gov/
1.
Understanding the resource challenges in
the screening process:
 Who should do it?
 When it should be done?
 Where is the best place?
2.
Developing and maintaining integrity
between the screening process and the
actual treatment of the offender.
 Consents,
 Agreements
 Incentives
3.
Understanding how security
classification, good time credit and
length of a sentence affects
treatment.
4.
Selecting the right AOD tool for
screening: e.g.
 TCUDSII,
 Simple Screening Instrument,
 SASSI, etc.
5.
The importance of sharing
information from the screening.
OK, you’re in!
No way, you’re
out!
Things to consider
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Cost wise, is it cheaper to have someone
dedicated to that particular task?
Can they be part-time?
Could the person even be an intern?
Can the client just fill it out?
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The when question; Timing is very important,
but so are logistics. Many, if not most
screening instruments can be administered in
a group setting.
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Choosing where to
do the screening is
important too. Is
the setting
conductive to an
interview process?
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Screen out offenders who do not need
substance abuse treatment.
Assess the extent of offenders' treatment
needs in order to make appropriate
referrals.
Ensure that offenders receive the treatment
that they need, rather than being released
into the community with a high probability
of re-offending.
Conserve assessment resources
Screening and in depth assessment
are important first steps in the
substance abuse treatment process;
currently no comprehensive national
guidelines for screening and
assessment approaches exist in the
criminal justice system.
In the absence of such guidelines,
information in this presentation
can help clinicians and counselors
and administrators develop effective
screening and referral protocols that
will achieve objectives relative to your
program design.
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Screening - A process for evaluating
someone for the possible presence of a
particular problem. The screening process
does not necessarily identify what kind of
problem the person might have or how
serious it might be but determines whether or
not further assessment is warranted.
Wearing multiple hats!
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In most settings, “screening” and
“assessment” are equated with “eligibility”
and “suitability,” respectively.
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Problem or No Problem – that is the
question
How long will the person be available
for treatment
What is their motivation for treatment
Community ties / religious preferences
Ability to participate
Security risk
Reentry issues (criminogenic needs)
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Infectious disease
General health screening
Co-occurring disorders
Cognitive functioning
Housing
Language/Cultural barriers
Suicide/Lethality issues
Literacy/Education
Setting
Jails
Purpose
• For early identification, if
getting out of jail early
• To determine eligibility for
drug courts and pretrial
diversion programs
• For diversion to specialized
mental health courts or
programs focused on
behavioral problems
• To determine behavioral
management problems and
acute needs (including crisis
intervention)
• To identify suitability for
placement in jail treatment
programs
• For classification to different
housing units
Special
Considerations
Look for previous
correctional substance
abuse treatment,
readiness for treatment,
past institutional behavior
problems, prior
correctional treatment,
and court orders.
Setting
Purpose
Prisons
• To match time left to
serve with time for
receiving treatment or
for custody level
classification
• To identify suitability
for placement in prison
treatment programs
Special
Considerations
Look at prison record,
treatment history
(including treatment for
issues other than
substance abuse), and
behavior.
Setting
Pretrial and
Community
Supervision
Purpose
• To determine the need
for housing, transportation,
employment, or economic
benefits
• To identify suitability for
placement in community
treatment programs
To assess for public safety
risk and level of
supervision needed,
pursuant to consideration
for placement in diversion
programs
Special
Considerations
Look for community or
corrections records or
collateral information
(e.g., information from
family members).
Selecting the right tools for your program
limited in focus,
simple in format,
quick to administer,
and usually able to be administered
by nonprofessional staff or in a
group setting
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Screening does not typically include
assignment of DSM-IV-TR (Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text
diagnoses of alcohol or drug abuse or
dependence and may only identify DSMrelated problem areas.
Screening tools do not include program
specific questions.
Revision)
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Ideally during the screening process
staff members would use instruments
that are
limited in focus,
simple in format,
quick to administer,
and usually able to be administered by
nonprofessional staff or in a group setting
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There are seldom any legal or
professional restraints on who can be
trained to conduct a screening.
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Purpose: The ASI is most useful as a general
intake screening tool. It effectively assesses a
client's status in several areas, and the
composite score measures how a client's
need for treatment changes over time.
Clinical utility: The ASI has been used
extensively for treatment planning and
outcome evaluation. Outcome evaluation
packages for individual programs or for
treatment systems are available.
A. Thomas McLellan, Ph.D.
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Groups: designed for adults of both sexes who are
not intoxicated (drugs or alcohol) when
interviewed. Also available in Spanish.
Norms: The ASI has been used with males and
females with drug and alcohol disorders in both
inpatient and outpatient settings.
Format: Structured interview.
Administration time: 50 minutes to 1 hour.
Scoring time: 5 minutes for severity rating.
Computer scoring? Yes.
Fee for use: No cost; minimal charges for
photocopying and mailing may apply.
A. Thomas McLellan, Ph.D.
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Purpose: The instrument is designed to predict
retention in treatment and is applicable to both
residential and outpatient treatment modalities.
Clinical utility: The instrument consists of four
derived scales measuring external pressure to
enter treatment, external pressure to leave
treatment, motivation to change, and readiness for
treatment. Items were developed from focus
groups of recovering staff and clients and retain
much of the original language. Clients entering
substance abuse treatment perceive the items as
relevant to their experience.
George De Leon, Ph.D., or Gerald Melnick, Ph.D.
National Development and Research Institutes, Inc.
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Groups with whom this instrument has been used:
Adults.
Norms: Norms are available from a large secondary
analysis of more than 10,000 clients in referral
agencies, methadone maintenance, drug-free
outpatient and residential treatment. Norms are
also available for specific populations, such as
clients with COD, prison-based programs, and
women's programs.
George De Leon, Ph.D., or Gerald Melnick, Ph.D.
National Development and Research Institutes, Inc.
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Format: 18 items at approximately a third-grade reading
level. Responses to the items consist of a 5-point Likert scale
on which the individual rates each item on a scale from
Strongly Disagree to Strongly Agree. Versions are also
available in Spanish and Norwegian.
Administration time: 5 to 10 minutes.
Scoring time: Can be easily scored by reversing negatively
worded items and summing the item values.
Computer scoring? No.
Administrator training and qualifications: Self-administered;
no training required for administration.
Fee for use: N/A.
George De Leon, Ph.D., or Gerald Melnick, Ph.D.
National Development and Research Institutes, Inc.
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Purpose: The purpose of the DAST is (1) to provide
a brief, simple, practical, but valid method for
identifying individuals who are abusing
psychoactive drugs; and (2) to yield a quantitative
index score of the degree of problems related to
drug use and misuse.
Clinical utility: Screening and case finding; level of
treatment and treatment/goal planning.
Groups with whom this instrument has been used:
Individuals with at least a sixth grade reading level.
Centre for Addiction and Mental Health
Canada
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Norms: Yes. A normative sample consisting of 501
patients, representative of those applying for
treatment in Toronto, Canada.
Format: A 20-item instrument that may be given in
either a self-report or in a structured interview
format; a “yes” or “no” response is requested from
each of 20 questions.
Administration time: 5 minutes.
Scoring time: N/A.
Centre for Addiction and Mental Health
Canada
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Computer scoring? No. The DAST is planned to yield only one
total or summary score ranging from 0 to 20, which is
computed by summing all items that are endorsed in the
direction of increased drug problems.
Administrator training and qualifications: For a qualified drug
counselor, only a careful reading and adherence to the
instructions in the “DAST Guidelines for Administration and
Scoring,” which is provided, is required. No other training is
required.
Fee for use: The DAST form and scoring key are available
either without cost or at nominal cost.
Centre for Addiction and Mental Health
Canada
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Purpose: SASSI is an objective screening tool
designed to identify patients with a high
probability of having a diagnosable SUD, which can
be used in a variety of clinical settings.
Clinical utility: Because some substance abusers
may not be able or willing to acknowledge relevant
symptoms, SASSI was designed to include both
face-valid items, which ask about lifetime
frequency of specific behaviors related to
substance use, as well as subtle true-or-false
items that have no apparent relationship with
substance abuse.
SASSI Institute
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Norms: Yes. 839 respondents were used to
evaluate the accuracy of the SASSI-3. The overall
accuracy of the SASSI-3 in distinguishing
substance-abusing and substance-dependent
respondents from those without a substance use
disorder was 94%.
Format: A 93-item instrument. 67 True – False, 14
face valued for other drugs, 12 for alcohol
Administration time: 20-30 minutes
Scoring time: 5-10 min
SASSI Institute
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Computer scoring? Yes. Also on-line testing
available
Administrator training and qualifications: Selfadministered; Non technical, step-by-step
information on administering and scoring the
SASSI-3
Basic information on interpreting profiles,
including several samples
Fee for use: Prices start at $125 for 25 paper test
and profiles. Computer software $215 for 25 test
and profiles, online pricing-pay as you go
SASSI Institute
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Purpose: The TCUDS-II is a self-administered tool
and serves to quickly identify individuals with a
history of heavy drug use or dependency (based on
the DSM and the NIMH Diagnostic Interview
Schedule) and who therefore should be eligible for
treatment options.
Clinical utility: It is particularly useful (and widely
used) in criminal justice settings, especially for
offenders eligible for treatment as an alternative to
regular incarceration.
Institute of Behavioral Research, Texas Christian University
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Norms: Yes. Numerous studies are available at
www.ibr.tcu.edu. Overall the TCUDS-II is 82%
accurate in identifying persons with SUD.
Format: A 15-item instrument. Available in Spanish
Administration time: 5-10 minutes
Scoring time: 5-10 min
Fee for use: No cost
Institute of Behavioral Research, Texas Christian University
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Purpose: The SSI-SA instrument, was designed to
encompass a broad spectrum of signs and
symptoms for substance use disorders. These
conditions are characterized by substance use that
leads to negative physical, social, and/or emotional
consequences and loss of control over one's
pattern and amount of consumption of the
substance(s) of abuse.
Clinical utility: Since its publication in 1994 the
SSI-SA has been widely used and its reliability and
validity investigated in 13 state correctional
facilities.
Center for Substance Abuse Treatment (Tip 11 consensus panel)
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Norms: Yes. Peters et al. (2000) found the SSI-SA
to be effective in identifying substance-dependent
inmates, and the SSI-SA demonstrated high
sensitivity (87.0-92.6 percent for alcohol or drug
dependence disorder) and excellent test-retest
reliability (.97). Knight et al. (2000) also found the
SSI-SA a reliable substance abuse screening
instrument among adolescent medical patients.
Center for Substance Abuse Treatment (Tip 11 consensus panel)
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Format: A 15-item instrument, can be administered
as part of an interview or self administered.
Administration time: 5-10 minutes
Scoring time: 5-10 min
Fee for use: No cost
Center for Substance Abuse Treatment (Tip 11 consensus panel)
The hand-off
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What are your barriers to sharing
information?
Can you utilize technology?
What will you share?
How will it be used?
Who will use the information?
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Eliminates redundancy
Confirm or refute self-report information
Encourages a team approach to the work
Promotes continuity of services across
departments or agencies
Protects the rights of the client
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Multilevel agreements
Understanding the rules on transmitting
health information
Using proprietary information systems that
are secure
Creating systems structure so not to violate
CFR 42 or HIPPA regulations
Q&A