Screening for Co-Occurring Disorders

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					    Screening for
Co-Occurring Disorders




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Take a Quick
Pre-Test




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               Learning Objectives

•   Know the definition and purpose of mental health
    and substance use disorder screenings
•   Explain the relationship between Screening,
    Assessment, and Treatment Planning
•   Examine screening issues associated with Co-
    Occurring Disorders
•   Gain a familiarity with various instruments used to
    screen for the presence of co-occurring mental
    health and substance use disorders



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  Relationships Among Screening,
Assessment, and Treatment Planning




                                     CSAT (2005c)



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           Issues of Screening and
             Assessment of COD

•   Presence of a substance use disorder can
    Mask Mental Health Symptoms
•   Presence of a substance use disorder can
    Mimic Mental Heath Symptoms




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           Issues of Screening and
             Assessment of COD
•   Substance use can precipitate mental health
    symptoms
•   Substance use can exacerbate mental health
    symptoms




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       COD TIP Definition: Screening

A formal process of testing to determine whether a
client does or does not warrant further attention at the
current time in regard to a particular disorder and, in
this context, the possibility of a co-occurring substance
or mental disorder.




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                  Screening

Screening for COD seeks to answer a “yes” or
“no” question:
• Does the substance abuse client being screened
  show signs of a possible mental health problem?
OR
• Does the mental health client being screened
  show signs of a possible substance abuse
  problem?



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       The Goal: Universal Screening

•   All individuals presenting for treatment of a
    substance use disorder should undergo, at a
    minimum, screening for any co-occurring mental
    disorders.
•   All individuals presenting for treatment of a mental
    disorder should undergo, at a minimum, screening
    for any co-occurring substance use disorders.




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                  Integrated Screening

      Integrated screening addresses both mental health
      and substance abuse, each in the context of the other
      disorder.




CSAT (2005c)


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   The Purpose of Integrated Screening

• To answer the yes/no question: “Is there sufficient
  evidence of a substance abuse and/or other mental
  disorder to warrant further exploration?”
• To begin the process of understanding the
  relationship between the mental illness and the
  substance use disorder




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       Comprehensive Screening

A comprehensive screening process also includes
exploration of a variety of related service needs
including:
• Medical needs
• Housing needs
• Need for victims’ services
• Presence of trauma




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          Screening Protocols must …

•   Indicate what constitutes scoring positive for a
    specific potential problem (often called “establishing
    cut-off scores”)
•   Detail exactly what is to take place when the client
    scores in the positive range (e.g., where the client
    is to be referred for further assessment)
•   Provide a format for recording the results of the
    screening, other relevant client information, and the
    disposition of the case


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     Features of Screening Instruments

•   High sensitivity (but not high specificity)
•   Brief
•   Low cost and no cost
•   Minimal staff training required
•   Consumer friendly




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                Who Can Screen?

•   Most unlicensed mental health and addictions line
    staff can be trained to screen.
•   However, not all persons trained to screen will get
    the same results
•   A successful screener is empathic, nonjudgmental
    and has no secondary agenda
•   A successful screener looks and listens for evidence
    of accurate reporting




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             Measures of Precision

Sensitivity: the probability that the screening test is
positive when a person has the disorder. This is also
known as the true positive rate. A high sensitivity
means that a negative test can rule out the disorder.




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        Measures of Precision (cont.)

Specificity: the probability that the screening test is
negative when a person does not have the disorder.
This is also known as true negative rate. A high
specificity means that a positive test can rule in the
disorder.




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        Measures of Precision (cont.)

Overall Accuracy: is the combination of sensitivity
and specificity—the probability that the screening test
will be positive when the person has the disorder
combined with the probability that the screening test
will be negative when the person does not have the
disorder.




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           Screening Instruments for CODs

See Handout: Screening and Assessment Tools List
Copies of the following are in your handouts:
Mental Health
• Mental Health Screening Form-III (MHSF-III)
Substance Abuse
• CAGE           AUDIT        CRAFFT (for use with
  adolescents)
• Simple Screening Instrument for Substance Abuse
  (SSI-SA)
TIP 42, Appendix G, pp. 487- 512 has list of instruments with descriptions and how they can be obtained.




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Post-Test and
Recap of
Screening for
Co-Occurring
Disorders



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