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SELECTING THE MOST APPROPRIATE ASSESSMENT TOOLS TO ENSURE EFFECTIVE TREATMENT PROTOCOLS FOR YOUR SUBSTANCE ABUSING POPULATION. A web presentation for RSAT - T&TA by Phillip Barbour -TASC This presentation builds on last month’s session on Screening. It addresses several issues relevant to assessment services and makes recommendations for the appropriate use of assessment tools in specific settings. Additionally, the conveyance of assessment information is critical to the service continuum. I will cover some of the finer points regarding HIPPA guidelines and 42 CFR Part 2 rules on consent and disclosure. 1. 2. 3. 4. Review of current assessment tools Assessing risk factors for the criminal justice client What tools are right for the job The conveyance of assessment information to providers http://www.kap.samhsa.gov/ Once a screening has identified the need for treatment, assessments should be conducted before clients are given more permanent placements. Assessments feed into treatment planning, decisions about treatment intensity, reentry, and continuing care. A process for defining the nature of a problem and developing a specific treatment recommendations for addressing the problem. Overall accuracy Sensitivity Specificity Positive predictive value Negative predictive value Are there normative scores for the population? Does the research show the instrument is valid for use with offenders and for relevant ethnic/cultural groups represented? Is it better to err on the side of false-positive or false-negative results? 1. 2. 3. 4. 5. 6. 7. Engagement of the client in the planning process Determine the nature of a problem Problem areas (domains) Understanding the client’s readiness to change Any diagnosis(es) Disabilities (accessibility to treatment) Strengths 1. 2. 3. 4. 5. 6. Standardized instrument (with norms) Administered by a trained professional Clinical diagnostic criteria used (DSM-IV) Risks assessment to help determine success or recidivism Client summary reports Initial treatment plan to share with providers REVIEWING THE DOMAINS Substance Use Substance use history Motivation and desire for treatment Severity and frequency of use Detoxification needs, acute intoxication Treatment history Criminal Involvement Criminal thinking Current offenses Prior charges & convictions Age at first arrest Type of offenses (correlation) Number of incarcerations Prior diversionary programs Prior successful completions of probation or parole History of any personality disorder Health Intoxication, infectious disease (tuberculosis, hepatitis, STDs, HIV) Pregnancy General health Acute conditions (things that can be treated and cured or stabilized) Mental Health History of suicide attempts or ideations History of treatment and prior diagnosis Past diagnoses Treatment outcome Current and past medications Acute symptoms Psychopathy Special Considerations Education level Reading level/Literacy Physical disability Developmental disability Learning disability Housing Family issues including dependants History of abuse (victim or perpetrator) Trauma related issues Socialization or re-socialization Evidence based, cost effective and scalable THE ADDICTION SEVERITY INDEX (ASI) GLOBAL APPRAISAL OF INDIVIDUAL NEEDS (GAIN) THE ADOLESCENT DIAGNOSTIC INTERVIEW (ADI) ASAM PATIENT PLACEMENT CRITERIA 2ND EDITION REVISED (ASAM PPC-2R) STAGES OF CHANGE READINESS AND TREATMENT EAGERNESS SCALE (SOCRATES) TCU CRIMINAL THINKING SCALES (TCU CTS) Evidenced based tools (research & norms) They build on the domains we discussed earlier They compliment or include screening tools to avoid redundancy They promote industry standards (a biopsychosocial approach) The tools are either public domain or nominal fees (but paid support is available) Scalable (as needs grow, so do the tools) A brief overview This ASI is an assessment instrument designed to be administered as a semi structured interview in one hour or less to patients who present for substance abuse treatment. The instrument gathers Information about seven areas of a patient’s life: medical, employment/support, drug and alcohol use, family history, family/social relationships, and psychiatric problems. Treatment Research Institute http://www.tresearch.org/ASI.htm Developed through a 10-year collaboration of clinicians, researchers, and policy makers from over a dozen agencies and localities, the Global Appraisal of Individual Needs (GAIN-I) is a progressive and integrated series of measures and computer applications. It can be done in pieces to facilitate screening, brief interventions, and referrals to treatment. Chestnut Health Systems, Chestnut Institute http://www.chestnut.org/li/gain/ The ADI systemically assesses psychoactive substance use disorders in 12 to 18 year olds. Based on Diagnostic and Statistical Manual (DSM) III-R criteria, this convenient structured interview also evaluates psychosocial stressors, school and interpersonal functioning, and cognitive impairment. In addition it screens for specific problems commonly associated with substance abuse. Western Psychological Services https://pubs.niaaa.nih.gov/publications TCU Criminal Thinking Scales (TCU CTS) is a supplement to the CJ-CESI-Intake and CJCEST and is designed to measure “criminal thinking.” The 6 CTS scales include Entitlement, Justification, Power Orientation, Cold Heartedness, Criminal Rationalization, and Personal Irresponsibility which represent concepts with special significance in treatment settings for correctional populations. (5-10 minutes) Institute of Behavioral Research, Texas Christian University http://www.ibr.tcu.edu/pubs/datacoll/cjtrt.html CFR42-Part2 & HIPPA and electronic records Applying the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE) In the early 1970’s, Congress recognized that the stigma associated with substance abuse and fear of prosecution deterred people from entering treatment and enacted legislation that gave patients a right to confidentiality. It’s been around for over 30 years. Confidentiality is a cornerstone practice for substance abuse treatment across the country. In December, 2000, the Department of Health and Human Services (HHS) issued the “Standards for Privacy of Individually Identifiable Health Information. HIPPA applies only to how information is stored and shared electronically If you are complying with CFR42 Part 2, there’s a good chance you will be in compliance with HIPPA. CFR Part 2 Programs = Treatment Providers ◦ Federal assisted, registered with the Federal Government, assisted by the IRS as tax exempt, receive any federal funding. QSO = Qualified Services Organization ◦ HIO = Heath Information Organization and Health Information Systems (HEI). ◦ One who stores data and patient records. Treatment Program CFR42 Part 2 Qualified Service Organization HIPPA Does federal law that protects the confidentiality of alcohol and drug abuse patient records allow information about patients with substance use disorders to be included in electronic health information exchange systems? YES: Part 2 permits patient information to be disclosed to Health Information Organizations (HIOs)2 and other health information exchange (HIE) systems For the purposes of the applicability of 42 CFR Part 2, does it matter how HIOs are structured? NO. HIOs may take any number of forms and perform a variety of functions on behalf of the health care providers and other entities participating in the HIO network.4 Regardless of the functions performed by the HIO, 42 CFR Part 2 still applies. provide the infrastructure to exchange patients’ health records among entities participating in the HIO network and facilitate the exchange of patients’ electronic health information; serve as a data repository that holds or stores patient records supplied by entities participating in the HIO network, and then makes them available for exchange in response to participants’ requests for such records; provide a record locator service for HIO participants and match individuals to their health records from different locations; or review and respond to requests for patient records from HIO participating providers. . Each of these scenarios involves the disclosure of Part 2 information. (QSOA) under Part 2, which is similar but not identical to a business associate agreement found in HIPPA is a mechanism that allows for disclosure of information between a Part 2 program and an organization that provides services to the program, such as an HIO it must enter into a two-way written agreement with the HIO holding and storing patient data receiving and reviewing requests for disclosures to third parties facilitating the electronic exchange of patients’ information through the HIO network Part 2 permits the program to freely communicate information from patients’ records to the HIO it is limited to that information needed by the HIO to provide services to the program Q&A This project was supported by grant No. 2010-RT-BX-K001 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the SMART Office, and the Office for Victims of Crime. Point of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice.