3.2A Lesson: Initial Screening

The Initial Interview: Collecting Relevant Information

          How you start out the intake, screening, or assessment interview process will affect the client's willingness to be candid and forthcoming in their responses to your inquiries. Smile. Make eye contact. Ask if they need something to drink, a smoke break or bathroom break before you begin (It's a good idea to have water and a bowl of hard candies available, as people often get dry-mouth when nervous). Start out by introducing yourself and describing what the interview will be like. Present yourself as a "helper", not as an "authority figure."  Many of our clients coming in for substance abuse treatment may have had previous negative experiences involving authority figures, either in childhood or as an adult. Ask the client about their prior experiences with intake interviews. Were these good experiences or was there some aspect of the experience that made him/her feel uncomfortable? Explain that some of your questions are going to be very personal and that they need to be in order to get accurate and sufficient information to develop a good treatment plan and a list of outside resources to meet their needs while in your program and beyond. Explain your role as a conduit (case manager) to other services they may require or benefit from. 

          There are two types of interview approaches: directive and nondirective. If you were a case manager utilizing a nondirective approach, you would passively absorb whatever information the client wished to share. This approach usually yields better rapport and more reliable information.  However, a purely nondirective approach produces less information. The directive approach provides structure and tells the client the specific information that is required. To be most effective, the case manager should use a combination of both approaches, starting out with a more directive approach and finishing up in a more nondirective manner. 

           Your starting question should be specific, clearly letting the client know what you wish to know. For example, "Please tell me what problems made you come here for treatment?" There are two types of questions you can ask: closed-ended or open-ended. Open-ended questions or statements are unlikely to be answered with one or two-word answers. In other words, you are asking a question in such a way as to force the client to elaborate on their answer--to talk awhile about what you asked. Open-ended questions broaden the range of information you are likely to get. Closed-ended questions direct the client to the information you want and can be answered usually in one or two words. 

Closed ended:  How many drinks containing alcohol do you consume each day?

Open-ended: Tell me about your usual drinking habits?

          The initial interview with the client should include questions that cover a significant width and depth to elicit a complete client history, information pertinent to assessing the needs of the client, the development of a diagnosis, determining appropriate services, and the client's level of motivation coming into treatment. The Outline of the Initial Interview Download Outline of the Initial Interview

 (Morrison, 1995, p. 8) provides a list of topics to cover with the client. If not appropriate for the initial screening because of time restraints or the client's inability to answer questions (client under the influence or highly resistant/uncooperative), then certainly this is information you would need to gather later during the assessment phase of case management. More than one session with the client may be necessary to gather all the needed information. In addition to the interview, various assessment instruments are available to target specific information. While it is important that you are aware of the many assessment instruments available, in this course, we will focus primarily on the Biopsychosocial Assessment (including the Mental Status Exam) and the Addiction Severity Index (ASI). You will also be learning how to assess for client strengths. 

Source: 

Morrison, J. (1995). The first interview. Revised for DSM-IV. New York, NY: Guilford Press.

What Not to Do When Screening

 

Selection of Screening and Assessment Instruments

Screening Instruments for Adolescents

          Selection of screening and assessment instruments intended for use with adolescents must be guided by several factors:

(1) evidence for reliability and validity,

(2) the adolescent population(s) for which the instrument was developed and normed,

(3) the type of settings in which the instrument was developed, and

(4) the intended purpose of the instrument.

Important features of screening and assessment instruments include

• High test-retest reliability: Are there similar results when the test is given again to the same youth after a brief interval (for instance, 1 week)?
• Evidence of convergent validity with other instruments attempting to measure the same construct: Is there a strong relationship between the results obtained from this instrument and the results obtained from other instruments designed to look at the same kind of problem (e.g., substance use disorder severity)?
• Demonstrated the ability to measure outcomes that correspond to criterion or standard for comparison: Has the test proved over time that it has helped to predict specific behaviors (e.g., performance in treatment) or clinical decisions (e.g., diagnostic decisions) in the same or similar populations?
• Availability of normative data for representative groups defined by age, race, gender, and type of settings: Has research shown evidence of a test's reliability and validity among different populations of young people (e.g., boys, girls) and in different kinds of settings (e.g., school, treatment programs)?
• The sensitivity of the instrument to measure meaningful behavioral changes over time: Is there evidence that the tool reliably measures the changes in a young person's behavior and related thinking?

          In addition to the above criteria, it is important to consider these features: The instrument should be relatively easy to administer and not burdensome in length; a detailed user's manual and appropriate scoring materials need to be available, and the cost of the materials for administering and scoring the instrument should not be excessive. See Chapter 3 for more on evaluating instruments.

          Substance use disorders invariably ripple out into other areas of a person's life, and this is especially true with young people who are developing emotionally, intellectually, and physically. Although this volume focuses on assessing the individual youth's problems as a foundation for treatment, programs involved with adolescent substance use disorders should also be a part of efforts to address the fundamental community and societal problems that contribute to adolescents' substance use disorders.

Screening Adults: General Alcohol and Drug Screening

As you read through the descriptions of each screening instrument, take a moment to click on the links in the Light Blue print. These links will open up the actual screening instrument for you to look at.  

A common criticism of the CAGE is that it is not gender-sensitive—that is, women who have problems associated with alcohol use are less likely than male counterparts to screen positive when this instrument is used. One study of more than 1,000 women found that asking simple questions about frequency and quantity of drinking, coupled with a question about binge drinking, was better than the CAGE in detecting alcohol problems among women (Waterson and Murray-Lyon 1988 Links to an external site.).

The CAGE is “relatively insensitive” with Caucasian females, yet Bradley and colleagues report that it “has performed adequately in predominantly black populations of women” (1998c, p. 170). Johnson and Hughes (2005) Links to an external site.conclude that CAGE has similar reliability and concurrent validity among women of different sexual orientations. The CAGE-AID (CAGE Adapted to Include Drugs) modifies the CAGE questions for use in screening for drugs other than alcohol. This version of the CAGE shows promise in identifying pregnant, low-income women at risk for heavier drug use (Midanik et al. 1998 Links to an external site.).

CAGE-AID  Links to an external site.