1. Assessment Tools for the Trainee Employee Assistance Program
By Diane A. Tennies, Ph.D., LADC
Lead TEAP Health Specialist
May 10, 2012

2. Assessment is One of Five Components of TEAP
This webinar will focus on empirically-validated screening and assessment tools available to TEAP Specialists to assist with evaluating students to determine how to most effectively assist them to complete the Job Corps program.

3. Learning Objectives After this webinar, you will be able to:
Identify the differences between screening and assessment inventories
List three reasons why assessment protocols enhance TEAP
Learn which of the commonly used assessment tools are empirically validated and recommended for use in TEAP
Begin to develop assessment protocols for their own TEAP programs

4. This is Screening

5. Screening
Screening for disease has become a mainstay of today’s preventive health care, with roots in medical practice that extend back to the 1930s and 1940s.
Increased screening allows clinicians to intervene early to prevent and treat a wide range of public health problems before they become too serious.
Routine screening for substance abuse relatively recent practice but has a solid base of support.
In 1990, the Institute of Medicine’s landmark report recommended patients in all medical settings be screened for the full spectrum of problems that can accompany alcohol use and, when necessary, be offered brief intervention or referral to treatment services.

6. Screening (Continued)
The term “screening” refers to the testing of individuals in a certain population to estimate the likelihood of a specific disorder.
It is NOT diagnostic testing, which establishes a definite diagnosis of a disorder.
Screening identifies people who are likely to have a disorder, as determined by their responses to certain key questions.

8. Screening (Continued)
What happens if “positive” on screening?
Further diagnostic testing to definitively confirm or rule out the disorder
A brief intervention (topic for another webinar)
Clinical follow-up
Screening and brief intervention has been shown to benefit those drinking at levels that place them at risk for increased problems but do not meet the criteria for alcohol dependence or abuse

9. What are we screening for?
A brief review

10. What is considered “risky” alcohol use?
Five or More Drinks for Men - Five or more drinks during any one drinking session, or more than 14 drinks a week
Four or More Drinks for Women - Four drinks or more during one drinking session or more than seven drinks a week
Drinking less than above places someone in the "low risk" category. According to research (NIAAA), only 2% of people who drink at those levels are at risk for developing alcohol abuse disorders or alcoholism.
Exceeding these guidelines increases risk for alcohol abuse or dependence with about 25% of people in this category developing alcohol problems.
NIAAA (National Institute of Alcohol Abuse and Alcoholism, 2007)

11. Drinkers’ Pyramid Alcohol Dependant—5% At-risk drinkers—20%
At-risk drinkers: targeted group, most likely to respond to intervention and represents greatest savings in care use and prevention.
Alcohol Dependant—5%
At-risk drinkers—20%
Low-risk drinkers—35%
Abstainers—40%
Source: Center for Substance Abuse Treatment: Background Paper, Screening, Brief Intervention, and Referral to Treatment (SBIRT)

12. Specific Screening Measures
The diehard of Substance Abuse Providers: CAGE
C Have you ever felt you should cut down on your drinking?
A Have people annoyed you by criticizing your drinking?
G Have you ever felt bad or guilty about your drinking?
E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
The CAGE can identify alcohol problems over the lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted.

13. But does it have Reliability and Validity in the JC Population?
Has high test-retest reliability (Dhalla & Kopec, 2007)
Adequate correlations with other screening instruments ( )
Works well in some medical settings (psychiatric inpatients) but not as well in primary care
Does best with more severe forms of drinking
Does not screen for drug use
Does not perform well for white women or college students
*Test-retest reliability refers a measure of consistency of a psychological test or assessment. This kind of reliability is used to assess the consistency of a test across time.

14. Conclusions
Let’s try something else that better fits the JC population and all its ‘developmental complexities’

15. Alcohol Use Disorders Identification Test (AUDIT)
Sample Questions:
How often do you have a drink containing alcohol?
How many drinks containing alcohol do you have on a typical day when you are drinking?
How often do you have six or more drinks on one occasion?
How often during the last year have you found that you were not able to stop drinking once you had started?
How often during the last year have you failed to do what was normally expected from you because of drinking?

16. AUDIT Has ten total questions Developed in 1992 Takes ten minutes
Developed by World Health Organization
Has some reliability and validity
Normed on heavy drinking and those with alcohol dependence
Content similar to CAGE

17. Alcohol, Smoking and Substance Involvement Test (ASSIST)
8 items but detailed
Developed by World Health Organization
Detect psychoactive substance abuse in primary care patients
Strong overall validity and reliability valid for males and females as well as cross-culturally
Innovative because can do online at:

19. CRAFFT
Screening tool recommended by the American Academy of Pediatrics' Committee on Substance Abuse
Normed on adolescents
Series of 6 questions developed to screen for high-risk alcohol and other drug use disorders simultaneously
CRAFFT is a mnemonic acronym of first letters of key words in the six screening questions.

20. 3 opening questions In past 12 months have you?
Drank any alcohol (more than a few sips)
Smoked any marijuana or hashish
Used anything else to get "high”
If the adolescent answers "No" to all three opening questions, then only ask the ‘CAR’ question.
If answers "Yes" to any one or more of the three opening questions, the provider asks all six CRAFFT questions.

21. CRAFFT – follow up questions
C-Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
R-Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A-Do you ever use alcohol/drugs while you are by yourself, ALONE?
F-Do you ever FORGET things you did while using alcohol or drugs?
F-Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
T-Have you gotten into TROUBLE while you were using alcohol or drugs?
Answers two or more = further assessment required

22. Conclusions on Screening
Efficient way to ‘screen’ for high risk
Can be done by other professionals and even in groups
CRAFFT recommended for use for this population and more efficient as screens for both alcohol and other drugs
Now incorporated into the SIF and will be reviewed by TEAP

23. Further Assessment and Evaluation
What are the ‘critical elements’?
Multiple data sources
Therapeutic alliance
Increased time and effort with individual focus
Narrow focus to specific issue to assess – individualized
What else in your ‘tool bag’?
What about validity of self-report and how do we enhance?
Reality of drug screening
Review the ‘data’ you have (653; SIF; other info in SHR)
Motivational Enhancement strategies – examples?

25. Value of an Assessment Process
How are ‘high-risk’ students identified in TEAP now?
Are there better ways to identify and intervene with the higher risk students?
What does screening and assessment ‘add’ to TEAP?
Improved identification means improved retention
Early intervention means improved outcomes
Enhanced therapeutic alliance for future interventions
Utilization of your skills as the ‘addiction specialist’

26. Assessment Tools Options
Many options – too numerous to mention.
These are well-established with adequate R/V:
SASSI-3/SASSI-A2
MAST
DAST

27. Substance Abuse Subtle Screening Inventory - 3
Used for abuse and dependence of both alcohol and drugs
Adult and adolescent version with obvious and subtle items
Has validity scales around test taking attitude
93 items
Administered and scored in about 15 minutes
Computer or hand scored
Overall accuracy in distinguishing people with substance misuse disorder from those without is 94%
Disadvantage = cost and time to hand score ($225 for 100 tests)

28. Drug Abuse Screening Test (DAST)
10, 20 or 28 item versions
Self-report with binary (yes or no responses)
Face valid*
Modified from MAST
Relatively good psychometric properties
*A test has face validity if it "looks like" it is going to measure what it is supposed to measure

29. Michigan Alcoholism Screening Test
One of most widely used measures for alcohol abuse
25 items
Paper/pencil or interview formats
Takes total of 15 minutes to administer and score
Good psychometric properties

30. Learning Objectives with the ‘Answers’
Differences between screening and assessment?
Three reasons why assessment protocols enhance TEAP?
Which assessment tools are empirically validated and recommended for use in TEAP?
Beginning to develop assessment protocols for own TEAP programs

31. Questions and Comments