1. Darren Urada, Ph.D. UCLA Integrated Substance Abuse Programs June 26, 2013 Integration Learning Collaborative: Screening Instruments

2. Today’s DiscussionToday’s Discussion Introduction Alcohol and Other Drug Screen Examples Mental Health Screen Examples Two-stage Screening Combo Screen Examples Tracking Patient Improvement over time

3. Introduction

4. Context: What do Federally Qualified Health Centers report doing? Source: National Association of Community Health Centers 2010 Assessment of Behavioral Health Services Provided in Federally Qualified Health Centers. http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf Caveat: Survey had a low response rate, screening’s % among all FQHCs may actually be lower.

5. Source: National Association of Community Health Centers 2010 Assessment of Behavioral Health Services Provided in Federally Qualified Health Centers. http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf Caveat: Survey had a low response rate, screening’s % among all FQHCs may actually be lower.

6. Source: National Association of Community Health Centers 2010 Assessment of Behavioral Health Services Provided in Federally Qualified Health Centers. http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf

7. Source: National Association of Community Health Centers 2010 Assessment of Behavioral Health Services Provided in Federally Qualified Health Centers. http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf Just because CAGE was reported as most common doesn’t necessarily mean it’s the best instrument to use.

8. Source: National Association of Community Health Centers 2010 Assessment of Behavioral Health Services Provided in Federally Qualified Health Centers. http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf http://www.nachc.com/client/NACHC%202010%20Assessment%20of%20Behavioral%20Health%20Services%20in%20FQHCs_1_14_11_FINAL.pdf

9. Alcohol and Other Drug Screening Instrument Examples

10. UNCOPE

11. UNCOPE Plus Dr. Hoffman & Alameda

12. AUDIT Alcohol Use Disorders Identification Test (alcohol only)

13. AUDIT C+ Alcohol Use Disorders Identification Test Plus Illicit Drug Questions

14. CAGE Alcohol Screen

15. CAGE-AID CAGE Adapted to Include Drugs One YES response indicates a possible problem. Two YES responses indicate a probable problem. Riverside

16. Addiction Severity Index- Multimedia Version (ASI-MV) San Francisco is piloting (very positive experience) Developed for use with adults seeking BH treatment Computer based program 30 day free trial available Website: www.asi-mvconnect.comwww.asi-mvconnect.com

17. CRAFFT (for adolescents) Sacramento

18. 1- Have you used drugs other than those required for medical reasons? Yes / No 2- Do you abuse more than one drug at a time? Yes / No 3- Are you always able to stop using drugs when you want to? Yes / No 4- Have you had “blackouts” or “flashbacks” as a result of drug use? Yes / No 5- Do you ever feel bad or guilty because of your use of drugs? Yes / No 6- Does your spouse or a parent ever complain about your involvement with drugs? Yes / No 7- Have you neglected your family because of your use of drugs? Yes / No 8- Have you engaged in illegal activities in order to obtain drugs? Yes / No 9- Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? Yes / No 10- Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis)? Yes / No DAST: Drug Abuse Screening Test

19. Ultra-Brief AOD Screens Alcohol & Other Drugs – 2 questions “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?” “How many times in the past year have you had 5 or more drinks in a day?” (4 or more for women) Yes to either question = positive

20. Mental Health Screening Instrument Examples

21. PHQ-9 is adapted from PRIME MD TODAY, developed by Drs Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. For research information, contact Dr Spitzer at rls8@columbia.edu.

23. Ultra-Brief MH Screens First 2 questions of the GAD-7. Score of 3 or more* = positive. Depression First 2 questions of the PHQ-9. Score of 3 or more* = positive. * use 2 or more to increase sensitivity (decreases specificity).

24. Two-Stage ApproachTwo-Stage Approach

25. Use the ultra-brief screens first –single question for alcohol –single question drug use –GAD-2 –PHQ-2 Use a second, longer instrument only for patients who initially screen positive, e.g. full AUDIT, DAST, GAD-7, PHQ-9

26. Combination Screening Instrument Examples

27. included with permission from: Center for Integrated Primary Care at the University of Massachusetts Medical School Note the title: “Patient Stress” - no stigma, everyone has stress!

28. Orange County SBIRT Screening Tool

29. Mountain Park Behavioral Health Screening Form * *

30. La Clinica de la Raza Behavioral Health Screening Form * * *

31. AC-OK Screen for Co- Occurring Disorders (MH, Trauma and SUD) By: Andrew L. Cherry University of Oklahoma School of Social Work For more info: http://faculty- staff.ou.edu/C/Andrew.L.Cherry- 1.Jr/AC-CODScreenPg.htm

32. Universal Screener (Kern Medical Center)

33. Tracking Patient Improvement Over Time

34. UNCOPE (see previous slide) AUDIT/ AUDIT C/C+ (see previous slides) Past-year, lifetime wording of questions is not ideal

35. TEA LA, Kern (pilot)

36. Other IssuesOther Issues Implementation: who does what, when? Assessment tools?

37. CONTACT Darren Urada, Ph.D. UCLA Integrated Substance Abuse Programs durada@ucla.edu