Agenda. 1. Why screen? Screening for substance use disorders. Screening in Minnesota. 1. Why screen for substance use?

Transcription

1 Agenda Screening for substance use disorders Cynthia Godin, M.A., Co-Occurring Disorders Policy Pamela Adelmann, PhD, Senior research analyst and COSIG project evaluator 1. Why screen? 3. Screens 4. Screening Protocol and Integrated Assessment 5. Substance Abuse Treatment Scale (SATS) 2 1. Why screen for substance use? Best practice approach Informative for treatment planning and interventions The presence of a co-occurring disorder is the expectation not the exception Screening in Minnesota Building a comprehensive approach along a service continuum Intensive Residential Treatment facilities Assertive Community Treatment teams Providers reporting on the POSR Outpatient mental health centers Outpatient chemical dependency providers and Rule 25 assessments Why screen? Who has been screened for something? For what? Hint: 5 6 1

2 1. Why screen......for these diseases in particular? high prevalence preventable, treatable if caught early save lives and improve quality of life reduce later costs certain groups? 1. Why screen... those at higher risk most payoff 9 10 Risk factors: Age Gender Behavior 1. Why screen... individuals who have a mental illness?

3 100 Rate of substance use disorder in a 12- month period, United States 100 Rates of mental illness and substance use disorder in a 12-month period, Minnesota Percent In the general Among those with population mental illness Source : National Household Survey on Drug Use and Health, Percent Substance use disorder, general population Source: Park, Substance use disorder, in those w ith mental illness Rates of substance use disorder in a 12-month period among those with various types of mental illness, United States first, understand the purpose of a screening tool 0 anxiety depression bipolar psychosis Source : National Comorbidity Survey, , and National Comorbidity Survey-Replication, The screening process for COD seeks to answer a yes or no question: Does the... mental health...client being screened show signs of a possible mental health (or substance abuse) problem? TIP Note that the screening process does not necessarily identify what kind of problem the person might have or how serious it might be, but determines whether or not further assessment is warranted. TIP 42 3

4 practical considerations? short easy to give and score low or no cost flexible format quality how was it developed, on whom, in what settings is it reliable and valid how well does it detect problems compared to a diagnostic test sensitivity, specificity Sensitivity: percentage of individuals with a disorder who score positive on a screen true positives How many of the big fish do you catch? Specificity: percentage of people without a disorder who score negative on a screening test true negatives How many of the little fish do you let go? it is preferable to cast a wide net and to be overinclusive rather than underinclusive in identifying these clients --Mueser et al. In general, it is desirable for screening instruments to have very high sensitivity, even at the expense of specificity. --TIP Example: GAIN-SS Combined mental illness and substance use disorder screening tool 5-item substance use disorders subscale (abuse, dependence)

5 3. GAIN-SS short? 1-2 minutes for SU section free? DHS has license for Minnesota providers to use it free of charge easy? reading level about 8 th grade positive score is any yes on a subscale flexible format? self- or staff-administered available in Spanish, Russian easy scoring 3. GAIN-SS quality? 3. Screens GAIN-SS SU (1+) Sensitivity 96% Specificity 73% GAIN-SS, SU subscale (Global Appraisal of Individual Needs-Short Screener) PSA (prostate cancer) FBG (diabetes) mammogram 63% 58% 89% 35% 77% 83% CAGE-AID (Cut down, Annoyed, Guilty, Eye-opener, Adapted to Include Drugs) FOBT colon cancer 30% 80% SSI (Simple Screening Instrument) Barium x-ray colon cancer 65% 60% Colonoscopy 95% 27 85% 28 GAIN-SS CAGE-AID

6 SSI Screening Protocol and Integrated Assessment Screening Policy: Each agency should have a screening policy that identifies which staff person(s) at your agency will follow-up with positive scores and when screens are done 4. Screening Protocol and Integrated Assessment continued Screening Protocol: Each agency should have a screening protocol that identifies the screening process: When is the screen done (is it at intake, self-report, by a MHP?), Who gathers supportive information (review psychiatric histories for past substance use history, contact other treatment providers, family?)

7 4. Screening Protocol and Integrated Assessment continued Screening protocol: who will follow-up with the client regarding their answers to the screen? 4. Components of an Integrated Assessment Comprehensive Longitudinal Assessment Contextual Assessment and Analysis Pay-Off Matrix Substance Abuse Treatment Scale (SATS) Substance Abuse Treatment Scale (SATS) Completing this question on the POSR Who should fill it out What is stagewise treatment? How is stage of treatment determined? What if you don t know the stage of change/stage of treatment to complete the POSR? Resources mn.us/id_ Issue 6 on screening Sources Journal of Medical Screening (e-journal), published by The Royal Society of Medicine Press. Preventive Care for Adults, phr/genericpage.do?pg=gprevcare.html Maciosek MV, Coffield AB, Edwards NM, Goodman MJ, Flottemesch TJ, Solberg LI. Priorities among effective clnical preventive services: results of a systematic review and analysis. Am J Prev Med 2006; 31(1): New study: screening for problem drinking is one of the most cost-effective clinical preventive services. National Comorbidity Survey-Replication (NCS-R), Online data analysis conducted by presenter

8 Sources Chan, Y., Dennis, M. L., & Funk, R. R. Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. J Substance Abuse Treatment 2008; 34(1): Screening: Technical assistance report for the Co-Occurring State Incentive Grants. SAMHSA, Co-Occurring Center for Excellence. Updated August Revised pdf Substance abuse treatment for persons with co-occurring disorders: A treatment improvement protocol. TIP books/bv.fcgi?rid=hstat5.chapter Dennis, M.L., Chan, Y-.F., & Funk, R.R. (2006). Development and validation of the GAIN Short Screener (GAIN-SS) for psychopathology and crime/violence among adolescents and adults. The American Journal on Addictions, 15(supplement 1),