Standardised screening and assessment

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The informal assessment process can be aided by a range of standardised screening and assessment tools. Standardised tools can be a useful means of gathering data by providing a reliable and valid view of the client’s difficulties and current life situation [297, 298]. Furthermore, when conducted appropriately, the process of standardised assessment can be a source of rapport building [299].

Groth-Marnat [274] suggests that when conducting standardised assessment, it is important to:

  • Provide the client with the reasons for assessment and the purpose of each instrument.
  • Explain that it is a standard procedure.
  • Explain how standardised assessment can be useful in helping clients achieve their goals (e.g., by providing an objective measure).
  • Provide appropriate and timely feedback of the results of the assessment.

Standardised assessment should be completed upon entry into and exit from treatment, as well as at follow-up [94, 300]. Test results can provide useful clinical information (for both the client and AOD worker) on the client’s case and an evaluation of how effective treatment has been. A variety of different tools are used, some of which are empirically established instruments, whilst others are purpose-built, internally designed tools with increased practicality and utility but unknown validity and reliability [267]. Some helpful screening tools have been included in Appendices I–R.

Standardised tools cover a range of areas that may be relevant to AOD services. The Camberwell Assessment of Need (CAN) is one of the most widely used needs assessment and treatment outcome tool [301] and has evidence to support its use among people with mental health conditions. It has also been validated for use in Australian populations [302], and can be used in clinical practice without staff training. The CAN assesses need in 22 domains, including accommodation, food, self-care, capacity to look after the home, daytime activities, physical health, psychotic symptoms, mental health and treatment, psychological distress, risk to self and others, AOD use, social relationships, child care, education, transport, budgeting, and benefits [303]. Several versions of the CAN exist, including:

  • Camberwell Assessment of Need Short Appraisal Schedule (CANSAS): For use in clinical work. The CANSAS allows the perspective of staff, clients and carers to be separately recorded. However, due to discrepancies in clinician and client assessments of need, a client rated short-form measure has been developed and evaluated (CANSAS-P).
  • CANSAS-P: A two-page version for clients, to complete. Evaluation of the CANSAS-P found it was able to better identify the needs of clients, particularly unmet needs [302].
  • CAN-Clinical (CAN-C): Detailed 22-page assessment, measuring the need rating, help received, and action plan for each domain.
  • CAN-Research (CAN-R): Detailed 22-page assessment, measuring the need rating, help received and satisfaction for each domain [304].

The CANSAS-P has been recommended as the preferred needs assessment measure for client completion [302], and is available in Appendix I. Further information about each version can be obtained through the CAN webpage: www.researchintorecovery.com/CAN.

There are also a wide range of standardised tools that can be used to screen and assess specifically for co- occurring mental health conditions. Here we provide an overview of some of these tools, with focus given to those that require minimal training to use and are freely available. A range of additional screening tools are described in Appendix H. It should be noted that some of these tools require specialist training, or else mislabelling, misinterpretation, or inappropriate use may occur [274]. Some tools are copyright protected and need to be purchased, and/or require the user to have specific qualifications. The requirements of each tool described here (and in Appendix H) are explained accordingly. It is important that workers are aware of what they are and are not trained to use, and seek training where required. Readers are also referred to Deady’s [301] comprehensive review of screening tools for use in AOD settings. This document is available online at www.nada.org.au.

It should be noted that following the release of the DSM-5, and at the time of writing, new measures were in the process of being developed and validated. As such, the measures below and in Appendix H include assessments validated for DSM-5, and where none are available, we have included measures developed with DSM-IV-TR criteria. Further disorder-specific assessment measures can be found on the DSM-5 website: www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures.

As mentioned earlier in this chapter, screening is designed only to highlight the existence of symptoms, not to diagnose clients. Most of the measures described are self-reporting (i.e., they may be self-completed by the client). Others, however, need to be administered by the AOD worker. Aside from the McLean Screening Instrument for Borderline Personality Disorder (described briefly in Appendix H), there are few brief measures with established reliability and validity for the identification of possible personality disorders. The possible presence of these disorders needs to be assessed by a health professional who is qualified and trained to do so (e.g., a registered or clinical psychologist, or psychiatrist).