3. Integrated Assessment For Co-Occurring Disorders

3. Integrated Assessment for Co-Occurring DisordersPeople with mental health disorders are more likely than people without mental health disorders to experience an alcohol or substance use disorder. Co-occurringdisorders can be difficult to diagnose due to the complexity of symptoms, as both may vary in severity. In many cases, people receive treatment for one disorderwhile the other disorder remains untreated. This may occur because both mental and substance use disorders can have biological, psychological, and socialcomponents. Other reasons may be inadequate provider training, screening, and assessment, an overlap of symptoms, or that other health issues need to beaddressed first. In any case, the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencinghomelessness, incarceration, medical illnesses, suicide, or even early death (SAMSHA).SkillKnowledgeResources/ Sources of Information3.1 Able to identify the purpose and thePer SAMHSA:Substance Abuse Treatment: Addressing the Specific Needs of Womenkey components of a comprehensiveScreening is a process for evaluating theThe Difference Between Screening and Assessmentassessment.possible presence of a particular 3/#tip51.ch4.s2Assessments are a process for defining theAlberta Health Services’ Enhancing Concurrent Capability: A toolkit fornature of that problem, determining amanagers and staff: Assessments, pages 7-13diagnosis, and developing s/info/amh/if-amh-ecctreatment recommendations for addressing comprehensive-assessment.pdfthe problem or diagnosis.Substance Abuse Treatment for Persons with Co-Occurring Disorders. Understand that in some instances theTreatment Improvement Protocol (TIP) Series, No. 42. Chapter 4information gathered in the screeningAssessmentsmay be used in the assessment re may be overlap in the processes.Co-Occurring Assessment Steps Understand that often an assessment isconducted by a trained professional who -Occurring Disorders (COD) Assessment Guidelinesis either licensed or certified to providemental health and/or substance usehttps://portal.ct.gov/treatment spdf.pdf?la en Understand that the purpose of anDomains Of Assessment For Co-Occurring Disorders :General Guidanceassessment is to collect, organize andfor Assessmentinterpret client information to viders/co occurring/admutually agreed goals that guideult services/assessment.htmltreatment.Key Areas to Examine in Assessing Co-occurring Disorders within the Understand that an assessmentestablishes a baseline of signs,Justice System page 22-24symptoms, and behavior to allow 0.pdfongoing monitoring of progressUsing the ASAM Framework for Co-Occurring Disorders Understand that conductingassessments throughout treatment

3.2 Able to conduct a collaborativeassessment that engages theindividual throughout the process. informs engagement, alignment, andprogress.Understand that in addition to collectinginformation on mental health andsubstance use issues, an integratedassessment includes a “whole person”approach that incorporates the followingbio-psychosocial factors that impacthealth:o Interpersonalo Developmentalo Physicalo Culturalo Behavioralo Spiritualo Lifestyleo Environmental/SocialKnowledgeable in how to structure anassessment and the pertinent biopsychosocial questions to ask.Understand that pertinent assessmentinformation includes and may not belimited to:o Information across time.o Both strengths and limitations, andcontext.o Information from not only theindividual but significant individualso Mental health, substance use andinteraction.o Motivation around changing forproblems identified.Knowledgeable of basic counseling skillssuch as active listening, reflecting, andsummarization.Understand the importance ofconducting a person-centeredassessment that elicits the individual’s:o Reason for entering (and staying in)treatmento Perception of CoOccurring-Disorders-PPT.pdfComprehensive Mental Health osocial Assessment - York cial-assessment-i.pdfSample Comprehensive als/formsamples 2013/adult comp assessment example jean.pdfAustralian Institute of Professional Counselors-Counseling Microskillshttps://www.aipc.net.au/student bonuses/Counselling%20Micro%20Skills.pdfAlberta Health Services’ Enhancing Concurrent Capability: A toolkit formanagers and staff: The Art of Assessment pages 13-31

oooo 3.3 Able to collaborate with collaterals togather additional information.3.4 Able to assess for current mentalhealth and history of mental healthissues.Priority problem areasDesired outcomesIdeas on how to accomplish goalsStrengths, capacities, andpreferences.Knowledge that a trauma history mayimpact the individual’s ability to fullyengage in the assessment process.Knowledge that stigma/shame mayimpact an individual’s ability to fullyengage in the assessment process.Understand cultural influences thataffect the assessment process.Understand the importance of revisitingcertain questions as the counselingrelationship progresses.Understand the importance ofidentifying psychosocial issues that mayneed to be addressed to facilitateparticipation in treatment for things likebasic needs, childcare, transportation,literacy. With the consent of the client,Understand the importance ofconducting interviews with familymembers, significant others, andproviders to generate a comprehensiveassessment.o Understand the barriers to receivingconsent (shame, stigma) and theimportance of revisiting permissionover time. Understand the importance of obtaininga history of past mental symptoms,diagnoses, treatment (includingresponse to / compliance withtreatment), prescribed medications, andmedication adherence. Understand past attempts at change dfPartnership, Engagement and Person-centered grams campaigns/recovery to practice/slides-engagement-20150831.pdfClinical Guide Integrated Dual Disorder TreatmentInteraction with Consumers pages 10-11 & Screening and Assessmentpages s/pdf/iddtclinicalguide.pdfSubstance Abuse Treatment for Persons with Co-Occurring DisorderAssessment Step 1: Engage the Client 197/pdf/Bookshelf NBK64197.pdfTrauma: The Therapeutic therapeutic-window/Building Shame Resilience in hame-resilience-in-clients/Improving Cultural Competence-Culturally Responsive Evaluation andTreatment Planning pages 931.pdfInterviewing Collateral Contacts - Pennsylvania Child OD3/Hndts/HO28 IntrvwngClltrlCntcts.pdfGetting Family Members Involved in Your Client's Recoveryhttp://www.bhevolution.org/public/iddt family education.pageCollaboration in Family MC4490859/Alberta Health Services’ Enhancing Concurrent Capability: A toolkit formanagers and staff: Assessments pages -Mental Health page /amh/if-amh-ecccomprehensive-assessment.pdfChapter 6 – Risk s/AU -2011.pdf

Understand family history of mentalhealth issues. Knowledge of the risk factors (history ofself-harm or violence, access to means ofharm, and stressors) and protectivefactors to consider. Understand the components of a mentalstatus exam (appearance and behavior,mood and affect, speech, thoughtprocess, thought content, cognition,insight, and judgment).3.5 Within scope of practice andtreatment setting, when a clientscreens positive for trauma-relatedsymptoms, able to follow up with amore thorough assessment.3.6 Able to assess for current and historyof substance use. Understand that there is a greaterlikelihood of having individuals with cooccurring trauma then many othermental health related symptoms anddiagnoses. Understand that for individuals withhistories of traumatic life events whoscreen positive for possible traumarelated symptoms and disorders, athorough assessment by a qualifiedindividual is recommended to gather allrelevant information necessary tounderstand the role of trauma in theirlives. Knowledge of the Adverse ChildhoodExperience (ACE) questionnaire, LifeStressor Checklist with interview, BriefTrauma Questionnaire, or similar tools. Understand that the ideal follow uptreatment would address trauma andother conditions. Knowledge of current substance use(including prescriptions) and history ofuse.Danger Assessment ental/Unit6 8 SuppEnhancing Risk Assessment across Mental Health ServicesPsychiatric Evaluation of ticle 1037&context psychiatrypresSample Risk als/formsamples 2013/risk assessment example jean.pdfMental Status 0Exam%20by%20John%20W.pptxTrauma Informed Care for Substance Abuse 118Trauma Informed Care in Behavioral Services- Chapter 4: Screening K207188/Screening and Assessment Considerations for files/resources/factsheet/screening and assessment considerations for implementation.pdfPrimary Care Trauma-Informed Screening and Assessment e-FINAL.docxACES and Trauma History s/initiatives/trauma/TIC Assessment.pdfLife Event Checklist with ssment/documents/LEC5 Interview.pdfAlberta Health Services’ Enhancing Concurrent Capability: A toolkit formanagers and staff: Assessments pages - Substance Abuse pages 48-49

3.7 Able to assess for interaction ofsubstance use and mental health Knowledgeable of the signs andsymptoms of substance misuse. Knowledge of intoxication, withdrawalsymptoms, and history of withdrawalsymptoms. Familiar with Post-Acute WithdrawalSyndrome. Understand severity of use andfrequency, duration and amount of use. Understand problems associated withuse. Understand patterns of high and lowuse. Understand family history of substancemisuse. Understand the importance of obtaininga history of treatment, includingresponse to / compliance withtreatment, prescribed medications andmedication adherence. Understand past attempts at change andrelapse. Understand the relationship betweencurrent substance use and mental healthsymptoms and functioning. Knowledge that the symptoms ofintoxication and withdrawal may mirroror exacerbate symptoms of mood andanxiety disorders (more common) andpsychotic disorders (less common).Often, symptoms of depression, anxiety,or other mental health issues improvewhen the person stops using substances. Familiar with the “teeter totterprincipal”- what goes up must comedown—which is useful to predict whatkind of symptoms might be caused bywhat substances. For example, acutewithdrawal symptoms from physiologicaldepressants such as alcohol andbenzodiazepines are t.pdfPost-Acute Withdrawal /post-acute-withdrawalsyndromeAddiction Severity Index - Fifth /Addiction Severity IndexBaseline Followup 4.pdfSubstance Abuse Treatment for Persons with Co-Occurring DisordersChapter 9 Substance Induced 78/Integrated Treatment for Co-Occurring Disorders- Complexities ofScreening and Assessment pages 46-47https://www.thenationalcouncil.org/?api&do attachment&name substance-usedisorders&index 0&type webinarsAlberta Health Services’ Enhancing Concurrent Capability: A toolkit formanagers and staff: Assessments Interaction Effects pages 34- 38Interaction of Concurrent Disorders page /amh/if-amh-ecccomprehensive-assessment.pdf