Informal assessment

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.
• Risk factors for CVD and other health conditions.
• Trauma history.
• Psychiatric history.
• Risk assessment.
• Criminal history.
• Strengths and weaknesses.
• Readiness for change.
• Beliefs about self, others, and the world.

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.