Informal assessment

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The informal assessment takes the form of a semi-structured interview and should cover the following:

  • Mental state.
  • Source of referral and current health care providers.
  • Presenting issues.
  • AOD use history.
  • Current situation.
  • Personal, medical, and family history.
  • Trauma history.
  • Psychiatric history.
  • Risk assessment.
  • Criminal history.
  • Strengths and weaknesses.
  • Readiness for change.

For an effective assessment, it is important to provide a non-judgemental, empathetic, private, and confidential environment. Any limits to confidentiality should also be explained.