 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. Hi everybody and welcome to your review of the process of screening. In this presentation we're going to review key skills for engagement, discuss factors impacting engagement, define screening, explore how to do a screening and identify types of screening instruments. Now screening is one of those steps that a lot of people will do, especially as a job, an entry level job in mental health. If you're working towards your hours for certification or licensure as an addiction counselor, you're probably going to be in a position at some point where you're doing a fair amount of screening. So let's learn how to do that. The first step in screening and assessment and even counseling is developing engagement. Engagement means that you need to develop verbal and nonverbal skills to establish rapport and promote engagement. So how do you establish rapport? How do you connect with somebody when they walk in the office? Do you sit down with a clipboard and start writing right away? No. You want to be able to be open, to be warm, to make eye contact, to respond to them in a culturally appropriate and culturally sensitive way. So you got to be aware of the people that you're working with, whether how much eye contact is enough, how much is too much, etc. You want to be able to talk to people. And a lot of people when they're coming in for a screening may not know what's going on. You want to be able to put them at ease. So hopefully, you know, those are the skills that you already have, which is one of the reasons that you're getting involved in this field. But screening means, you know, first and foremost developing that relationship. Because the quality of the relationship with you is going to determine in many cases whether somebody goes on for the assessment and treatment if needed. You want to discuss with the clients the rationale, purpose and procedures associated with screening and assessment. So sit them down and say, you know, we're going to do a screening for substance use, or we're going to do a screening for depression. This is why we do it, you know, because we know that whatever percentage of people in this area struggle with depression and that early intervention is a whole lot more effective than late intervention. So the earlier we can help people arrest the problem, then the better off they're going to be. And this is what a screening is going to be. You know, so they know if they're going to get, they're not going to get their blood drawn. They know you're just going to sit there, you're going to ask them five or six questions and they're going to be done. Because they may be thinking that, you know, they need to lay on the couch and tell you their deepest, darkest secrets and they're not ready to do that. Well, of course not. They just met you. So let them know this is what screening is. Assess clients immediate needs, including detoxification. If you're meeting with somebody and, you know, you notice that they're under the influence of substances, then they may need detoxification. If you're assessing them for substance use or substance use disorders and they admit that they have been using consistently or they're under the influence, they may need detox. Administer evidence-based screening and assessment instruments to determine clients' strengths and needs. And we're going to talk about some of those evidence-based instruments later. But, you know, you can use the cage, you can use the sassy, you can use a variety of different instruments. Obtain a relevant history to establish eligibility and appropriateness of services. Wherever you are, you know, you probably accept some insurance, don't accept others, you may have private pay, you may not. We want to make sure that once we screen, we can get the person into services that they may need. You know, so we need to determine where can they go? You know, if they've got Medicaid, if they're private pay, if they've got private insurance, you know, where's the best referral place for them? And in order to do that, we need to get that relevant history. Other things that affect eligibility- well, appropriateness for certain treatment programs. Some treatment programs will work with people who are on benzodiazepines. Others won't. So this history is important to figure out, does this person need a specialized program? Are they dealing with specialized issues like LGBTQ issues? Are they, if they're an adolescent, obviously they're going to need an adolescent program. So we need to get all of this stuff. You know, when we're doing the screening, we're going to get a little demographic data there. And we're going to do the screening. Screen for physical needs, medical conditions, and co-occurring mental health issues. So while a screening for substance use may be five questions, a full screening is probably going to take 20 or 30 minutes. So we're going to ask them a variety of questions. We're not going to get super in-depth, but we are going to get sort of an overview of how this person is doing. That way we can look at it and see how this person is doing. That way we can look at it and say, you know, maybe they've got medical conditions that are contributing for screening for depression. Maybe they've got medical conditions that are contributing to their depression. If they have a substance use disorder, you know, are their medical conditions being made worse by their substance use? And if so, what do we need to do? So we want to, you know, screen. We want to screen for co-occurring mental health issues. It does not really matter if the person had depression or anxiety or bipolar before they started using or they developed depression or anxiety after they started using. Right now, there, if they have depression or anxiety, it needs to be addressed because you can't have somebody sober up and still feel miserable and expect them to stay sober for long. Likewise, you know, you can't just treat their mental health issue and expect the substance use just to go poof. So if they, if you're screening for one, it's really important to screen for the other. Substance use will monkey with the neurotransmitters that can contribute to depression and anxiety. So, you know, if they've got substance use, we want to screen for that. Mental health issues, sometimes people will self-medicate to try to numb the pain of mental health issues. So again, always screen for both of them because the likelihood is if one exists, the other exists at some level as well. Interpret results of the screening and assessment and integrate information to formulate a diagnostic impression and determine the appropriate course of action. So you're not doing a full diagnosis, but you're going to go through and you're going to look at the screening results and say, yep, you know, technically this person meets the criteria for substance use disorder. So we need to send them on for an assessment to see what may need to be done and what our options are to help them deal with it. If you're screening for depression, the same thing is going to be true. This person meets the criteria. You know, we suspect that they may have major depressive disorder. So let's refer them for an assessment so we can figure out what's causing the depression and what options we have for helping the person deal with it. We want to develop a written integrated summary to support our diagnostic impressions and you're going to do more of that with assessment. But in the screening, you know, the assessor is going to want to know why did you send this person? So you're going to present a summary of the information that you gathered that told you that this person may need to be assessed for substance abuse or mental health issues. You know, it doesn't have to be a dissertation. It can be a paragraph. But you do want to kind of put it all together in a nice little package so the assessor doesn't have to go back and read through everything and try to figure out what you saw. Establish rapport and an effective working alliance in which the client feels heard and understood. You know, be respectful. Make eye contact, smile. You know, don't go directly to your paperwork and make them feel like a number. Be punctual. That's really important. Be non-judgmental. If they're talking about their substance use, don't act shocked. Like, oh my gosh, I can't believe that you drank while you were pregnant or oh my gosh, I can't believe that you're using that much of that substance or you did that in order to get your drugs. No, they did what they did to survive. They did what they did to survive given the tools that they had at that point in time. We weren't in their shoes, you know, thereby, but the grace of God goes I. So we want to remember that people did what they had to do and it got them here and it helped them survive until now. And we want to be attentive. If we see that the person starts moving around in their seat a little bit, you know, ask them, you know, are you uncomfortable? Is there something I can do to make you comfortable? They may be uncomfortable about what you're talking about. They may be, you may be running late and, you know, you've been in the session for 30 minutes and they need to go or they may need to go to the bathroom or they may be thirsty or cold. You know, if you see them starting to become a little bit fidgety and not necessarily even agitated, ask them. You know, it seems like you're becoming a little bit anxious or something. I'm wondering if there's something you need, something I can do to help. That will go a long way to helping them feel like you care about them. Motivate and engage the client in identified service needs. So if you determine that they need an assessment, you're going to have to motivate them to go. So help them see how going to an assessment could be beneficial to them, how it could help them meet their life goals. Engagement puts the clinician in the best position to negotiate with the client about what to do and how to do it. So assessment is usually done at whatever treatment center that you're hoping the person is going to be enrolled in. So we want to talk with them during the screening about what is it, what type of center do you want to go to? Is there a place that you have in mind? Are there particular characteristics of treatment that you're hoping to experience or likewise not experience? Some people don't want to be in a hospital type environment or whatever. So start talking with them about what their options are and negotiate with them. If you think they need an assessment and it's likely they're going to need to go to residential, you might want to start moving them toward the four or five options that offer that service and encourage them to go. And if they don't think they have a problem, they may not be willing to go yet. If they think they've got a problem, make sure that the handoff goes really well to that agency and not within your same agency. Make sure that that referral goes really well and that they are received equally warmly by the assessor at that agency. Help them feel comfortable going to do this. If you give them a referral and just say, here, go to this place and they'll take care of you. The person may be like, I don't know where it is. I don't know who this person is. If you hand them this and say, you know, go down to this place and do you know how to get there? So let me draw you a map and then help them know how to get there and then you're going to meet with Jane at this facility and she's going to do your assessment. I've worked with Jane for years. She's really awesome. You know, she'll take her time listening to what you have to say and what your wants are. She's not going to force you into anything you don't want. That goes a whole lot further to motivating the client to go because they're not apprehensive about the world am I walking into. Engaged clients are more likely to participate willingly, be treatment compliant and successfully complete treatment. Now engagement doesn't stop when they leave the screening. That's just the beginning, but you are the face of the mental health system, so to speak, because you are the first person that they interface with. So you kind of set the tone for their experience most of the time. Create a welcoming environment that's pleasant and sensitive to age. If you're working with kids, don't have a sterile environment with only big people chairs. Have little people chairs and have books that are appropriate. Have it be sensitive to gender. Men aren't going to be wanting to sit in an office that everything is pink and frilly and whatever. Likewise, adults aren't going to want to sit in a playroom to do counseling. Make sure you've got age-appropriate stuff in the room that you're working with. Make it sensitive to disability. If people have hearing disabilities, make sure that you can talk loudly enough that they can hear you. Make sure you minimize extraneous noise that may keep them from hearing you. Make sure the area is compliant with the Americans with Disabilities Act, so people who are physically disabled can get through doorways and things like that. The physical environment should be sensitive to sexual orientation. Have little clues around that you are accepting of the LGBTQ lifestyle. A rainbow flag on your desk or something, it doesn't have to be huge. Just little things in the environment that say, hey, I'm cool with whoever you are because you're an awesome person. Same thing with religion. Try to make sure the assessment environment is friendly and not necessarily oppressively religious. If you have a cross here or a prayer there or something, that's fine. That's your expression of who you are. But we want to make sure that people who are of a different religion or who are atheist don't feel oppressed in that environment. Likewise, people who've been traumatized potentially through their church in some way or another. That may be off-putting if they see that. Be cognizant of the things that seem benign to you and what they may mean to the people who are coming in for screenings. Make sure your environment is sensitive to socioeconomic status. What I mean by that is have a pleasant environment for everybody. People who are from a higher socioeconomic status, for example, are probably going to expect a plusher environment and a much different experience, more concierge type services than somebody who is of a middle class or lower socioeconomic status. Now, does that mean you can just throw folding chairs out for other people? No, we want to make sure everybody is comfortable and they feel kind of like it's their living room. We don't want them to feel like it's a sterile, scary environment. But you do need to pay attention to what is this person or what are the people in my community expecting when they come in. Factors impacting engagement can include stigma about the diagnoses or even about help seeking. Not everybody is cool with counseling. Some cultures say, you know, counseling brings shame on the family. Some, you know, older people, like my grandmother's age, back then in the 1940s and 50s, you didn't tell other people your stuff. So be conscious of the fact that just being there may be really overwhelming for people. People's expectations about the effectiveness of treatment can impact their engagement. If they've been in treatment before or they've known somebody who's been in treatment before and it just never seems to work, then they may be there because they have to be for some reason, but they really don't expect you that your engagement's going to be low. One of the things you can do with those people is make sure you have some tools in your toolbox that are brief interventions that can help them start feeling better today, you know, tomorrow, something like that. So talk with them, sleep is one of the first and easiest things to start addressing. You know, talk with them about their sleep hygiene patterns, you know, because people's inability to relax can contribute to depression and anxiety and a whole bunch of other stuff. So, learn about sleep hygiene and how to create a good sleep routine and encourage them to start doing that or encourage them to make a list of the people and things that are important to them so they can figure out where they're going from here and they can figure out why they're doing all this. So, find a couple of tools that you can give people so they can focus on the fact that, yeah, this might help me and it might actually help me move towards my goals and, oh, by the way, I'm starting to figure out what my goals are. People may have expectations about their role or power in the treatment process so we want to make sure that clients understand that they are in charge. They are in charge of their treatment. I can't make them, you know, unless I have to do an involuntary commitment, but that's something a therapist is going to do or a psychiatrist. But 99.99% of the time you want to work with the client and they're going to be the ones to tell you what's worked in the past, what hasn't worked in the past, what's working right now, even a little bit and you're going to talk about ways to enhance that, you know, we're not going to force them to do things that they don't want to do. And they may have certain expectations about treatment itself, so we want to dispel any myths about what treatment is like. We want to help them know what our facility or the facility we're referring to can provide in terms of treatment. And we also want to just help them understand what to expect so they're not apprehensive. And your likableness, I hate to say it, but your likableness and their likableness are going to impact engagement. If somebody comes into your office and you're doing a screening and they are just, they have no social skills, they're not attentive, they're not attractive, they're not happy, they're just mean and cantankerous, it's going to be hard to engage them. And it's going to take an extra effort on your part to try to hear where they're coming from and hear what's important to them and form a bond. So the client's social skills will impact engagement. If they don't have great social skills, you know, you got to work with it. And, you know, if they're I had one client that blessed his heart, he was in college and he would still pick his nose and eat it. And you know, I had a hard time focusing when he was doing that. So, you know, I got to the point where he would do it and as soon as he'd pick his nose, I'd pick up a tissue and hand it to him and go, here you go. Looks like you need that. But those are things that you can run into when you are working with clients. And you need to keep that from causing a barrier in your ability to engage with them. If they're not attentive, ask them why, you know, or try to look for reasons why they're not attentive. You know, you seem to be kind of distracted. Is there something I can do to make you more comfortable? And, you know, it's just human nature that we tend to be more engaged with people who are not everybody's attractive. So, you know, focus on what the person has to say and what their heart has to say in order to engage. And, you know, likewise, you may not be right off the pages of Vogue either, but try to present yourself well. Try to, you know, dress appropriately. Don't show up all disheveled and smelly clothes, like looking like you haven't bathed in a week. That's not helpful. So, making sure that you're presenting your best face and you're dealing with whatever face the client brings and still trying to build that engagement. Remember, the way a client presents themselves tells us a lot about what's contributing to their presenting issues. Poor social skills, ADHD, pain, you know, there are a variety of things that can contribute to depression, anxiety, and substance use. So, try to look at it from that way. Even if it's not your ideal client, understand what's causing this person to be negative and just argumentative and frustrating. Try to get under there and figure out why is this person so unhappy? What's motivating that? First impressions, impact engagement. So, your professional presentation, being prompt, being courteous, and smooth handling of paperwork. If you walk in there with 15 sheets of paper and you're shuffling them around and it seems like you don't know what you're doing. You're like, just a second. I know I had that form around here somewhere. They're not going to feel very confident in anything you have to say. So, put on a good first impression. Put it together. Make sure your paperwork is put together ahead of time. If you have an electronic medical record, make sure you know how to use it because it's disturbing to people even though it happens when you're using an electronic medical health record to do a screening and you get stuck and you've got to call somebody else in to help you figure out how to get on the next screen. Make sure the environment is calm, clean, and comfortable. Not too formal or informal like we talked about. It avoids interruptions and provides the appropriate level of privacy. You don't want clients sitting in the waiting room being able to hear other clients that are in the therapy rooms or the screening rooms. If you're doing screenings, you may not even be in an office. You may be out at a festival or something. So, make sure that you've got little pull-around screens or something if appropriate in order to give people privacy. Other people shouldn't be hearing their responses to what you are asking them. Even if it's a workplace festival or something, other people should not hear their answers. So, how can you give them privacy? If there's no way to do that where they can have auditory privacy, put as much as possible on check sheets and forms that they can fill out and then you can point to something and go, help me understand your answer to this right here. Most of the time, you really want to try to do screening in a private room. In the initial interview, you're developing trust and rapport. So, be empathetic. They're nervous probably or they don't want to be there or maybe they do want to be there and they're just hoping that you can help. Paraphrase that to them. Whatever vibe you're getting off of them, paraphrase that and work with it. Convey warmth and respect and explore the client's strengths and skills. You know, you've been dealing with this depression or this addiction for a really long time. I'm wondering how you've survived until now. What has helped you deal with it and keep on keeping on? Facilitate the client's understanding of the rationale, purpose and procedures of the screening and assessment. Explore the client's problems and expectations regarding treatment and recovery. And determine whether a further assessment is needed. Bada bing, that's your screening. So, the definition of screening is the process by which the counselor, client and significant others, when possible review the current situation, symptoms and collateral information to determine the probability of a problem. So, we're going to sit down and we're going to go, okay, what brings you here today? What makes you think you got a problem? You know, and then we're going to start asking questions or using instruments to try to determine whether we think that there's a probability that that problem exists. Screening is used by all types of human service personnel to determine eligibility and appropriateness of services and needed referrals. So, it may be used by a physician, by a nurse, by a counselor, by a case worker. In order to determine how can we best help this person achieve their goals and their maximum quality of life. It's not unusual for case workers at Department of Children and Families, if people are coming in to get their food stamps or EBT that month or they're enrolling in the process to do a screening to determine how can we best help this person you know, be able to start earning more money. You know, maybe they just need a better job or maybe they're not able to maintain employment because their depression is so oppressive. So, you can see where screening may be used in a lot of different systems and situations in order to help people figure out how to help their customers. Screening determines the immediacy of need. You know, you could be doing a screening with somebody who's like on the fence or they don't think they've got a problem and it, you know, or their problem is minor. So, the immediacy may not be great. Or you could be screening somebody who is, you know, heavily intoxicated, was just kicked out of his house, is facing 3DUIs. You know, they have a much more immediate need for their personal safety as well as hopefully they're more motivated. Screening needs to be a transparent process. We don't want to sit there with a clipboard and be asking questions and scribbling things down and going, uh-huh, uh-huh. Well, I think you need to go for an assessment. That's not transparent. The client's like, where did you come up with that from? I usually use screening instruments and I talk with people and when I'm writing things down I tell them at the end, if you want to see anything I wrote down I would encourage you to. You know, I don't write well. I've got poor penmanship but I encourage you to read what I wrote and we're going to talk about these instruments after you take them. So you know, you know, why were we asking these particular questions? What does it mean to me as a therapist doing your screening? So they understand how you're arriving at your conclusions. Screening does require informed consent. You know, it doesn't have to be a big thing but it does have to happen before you start screening somebody you need to go, you know, I'd really like to screen you for depression or anxiety or this is a screening that your agency is offered. But have them ideally have them sign a sheet acknowledging that they know that they're being screened for whatever. And screening identifies early warning signs and helps provide early intervention services and resources. So, you know, think about high blood pressure or diabetes or any of those physical things. Doctors screen for that regularly and if they see that there might be a problem creeping in, they can do something right then to keep it from becoming a full blown problem. Mental health screening is the same. We notice people are under a lot of stress. We know that that's probably going to wear them out after a while and it might lead to depression. So we can start helping them develop stress management skills, for example. They may not need to go to treatment. Maybe they need to go to psychoeducation and learn about stress management or maybe you've got a book you can let them read or something. But screening is a method of determining what the person needs. Screening is the first opportunity to engage the client in the therapeutic relationship and treatment process. Sometimes based on observations or other circumstances, people may be referred directly for assessment. For example, if people come into the detoxification unit, we kind of bypass screening. We know there's a problem and jump straight into assessment. So screening doesn't always happen but a lot of times it does because that referral source if you're an assessor, that person came from somewhere. Their lawyer could have screened them, their doctor could have screened them, whatever. But somebody along the way probably screened them to determine, yeah, you probably need to go over to this facility and talk to an assessor. The client's internal motivation is the primary reason for engaging in treatment. So if they're there because their wife told them they had to be or their boss or the courts, that got them there. But to get them actually engaged in treatment and not just going through the motions, they have to have internal motivation. There has to be something in it for them. And that's what we want to work on developing throughout the whole process. Help them see how this benefits them. What's in it for them? How can it help them accomplish and get closer to their goals for their life? Internal motivation may be fleeting. So rapid engagement is vital. If you see a spark of interest or a spark of willingness, we kind of need to pounce on that spark and go, alright, it seems like you really want to get on with this because you're sick and tired of being sick and tired. So let's you enrolled. Now, if you have to make an appointment for an assessment that's six weeks out, you may lose the person. You know, that engagement doesn't last for long. The engagement lasts while they're in your office. And then you know, you got to have somebody else pick it up and keep that momentum going. Screening should be brief. You know, 20, 30 minutes. You don't want to have somebody in there for three hours. That's the assessment. It's conducted in a variety of settings by a range of professionals on persons deemed to be at risk. Some things we do universal screenings for like domestic violence. Other things you may do selected screenings for. And it also depends on your setting and all that kind of thing. But the take home point is that screenings are conducted in a variety of settings whether it be a health fair at an employer's office. Sometimes churches will even set up wellness days and do screenings. Screening represents the first part of a collaboration among a multidisciplinary team because the screener is going to say, okay, I think I've identified that this person probably has an issue with this and needs to be referred to assessment over here. But they also need help with housing and food and affording their prescriptions. So the screener will kind of link them to other team members in the multidisciplinary team. Screening needs to be sensitive to racial, cultural, socioeconomic, and gender related concerns. So make sure that you're culturally responsive. And it needs to be developed from information gathered from multiple sources when possible. When you're doing a lot of times, the only person you've got to do the screening with is the person sitting right in front of you. But if you've got other information, when I do screenings on people in the criminal justice system, I want to see their criminal record. You know, that gives me some objective information on, you know, how many times have they been caught DUI? Whether or not they've been convicted, how many times have they been caught DUI? And that gives me a little bit more information than just what that person is telling me. If they've been involved with the Department of Children and Families, I want them to bring their case report, especially if they've got an open case going on. Screening assesses signs and symptoms of intoxication and withdrawal. Three key elements. We want to verify that the behavior deviates from the norm. Rule out all non-drug related causes. So if somebody is having difficulty focusing or they're agitated, we want to rule out ADHD and schizophrenia and some other things that might cause that in order to rule in, if you will, stimulant abuse, for example. So you want to verify that they're, this is not how they normally behave. You know, some people are agitated and a little bit more bouncy or fidgety or whatever you want to say most of the time. If that's how they are, then that's how they are, and it's not a drug. Want to rule out the drug related causes, including physical causes, if they're in chronic pain, etc. There are a lot of reasons somebody could be excessively sleepy, have difficulty concentrating, be overly agitated. There are a lot of things. Use diagnostic procedures to determine the types of drugs being used. So in a screening, we're going to ask them what they've been using, but ideally you can also do an on-site drug screening. You know, have them be in a cup and the on-site screenings are not super reliable but it gives you something to look at. You know, most cases it's anywhere between 60 and 70% reliability which is why, if it comes up positive and the person says, I didn't use that, it needs to be sent off to a lab for mass spectrometry in order to determine what happened because you can get false positives and you can get false negatives. So they may have used something and it doesn't show up on the test. You don't want to just trust the on-sites as being 100% but it is a good tool to identify whether the person is telling you the truth about how much or what they're currently using or not. Assess client's mental health and trauma history. You're not going to get deep into the weeds here. Just ask them if they have a history of depression, anxiety, abuse of any sort and move on. Their safety or environmental needs. Do they have a safe place to sleep? You know, if they have a dress, you know, do they feel safe in their home? Do they eat well? How's their nutrition? Do they have any physical health needs that are not getting met? Do they have any other wrap around needs? If they've got kids, do they have access to child care? Are they having problems with transportation? Are they able to afford their medications that they're already prescribed, etc? We want to ask them about some basic things like that and then we're going to assess danger to themselves and others. Are they talking about harming themselves or someone else? We also want to ask if they're thinking about hurting themselves or someone else. Screening methods include interviewing the clients and significant others, using screening instruments and lab tests like the urinalysis that we talked about. Signs of substance use disorders or mental health issues. We want to look for number one, the circumstances of contact. If the person was referred by the courts, then that's a pretty good sign that there's maybe a substance use disorder going on if they're referred because of a DUI, for example. If they're referred because of a fight they got into but they weren't using at the time, their blood alcohol was 0-0 we want to look maybe for mental health issues and things like intermittent explosive disorder. You want to look at the client's demeanor and behavior. Are they acting like they're under the influence when they come in for the screening? Are they showing signs of acute intoxication or withdrawal? Are there any physical signs of drug use or self-injury? Needle injection marks if they have a get frequent bloody noses if they get bloody noses while they're in your office or if they have signs that they've been picking. Those can be all physical signs of drug use. Amaciation and malnutrition also signs. Some drugs will cause the pupils to be really dilated. Other drugs will cause the pupils to be pinpointed. You want to know what the signs of different drugs are for drugs of intoxication and different signs that people have been using drugs especially injection but like I said, sometimes drugs will cause people to pick or itch and that will indicate to you that there might be an underlying issue. Information spontaneously offered by the client or significant others can give you information about whether there's a substance use or mental health issue. And sometimes the significant other, let me just kind of back up there maybe the spouse brought the person in and when you go out to meet them the person being interviewed doesn't really want their spouse in there. They want to go back by themselves. Okay, that's cool. You go out and meet the person and then if you can with permission, bring the spouse back after the screening to give them both the results and at that point, the significant other the spouse may spontaneously say, oh well, why didn't you tell them about the DUI you had three years ago or whatever. So sometimes spouses will just kind of blurt things out because they suspect that the significant other didn't already say it during the interview. So if you can get that person in a private place where they have an opportunity to say something, that's wonderful. But remember you do have to have the client's permission. Screening instruments can be developed by the agency or use standardized instruments. The cage is a really common one and you ask a person have they tried to cut down unsuccessfully? Do they feel annoyed when people talk to them about their substance use? Do they feel guilty about the substances, about using their substances? And do they sometimes have to use first thing in the morning to kind of wake up? We call it an eye-opener. If they say yes to one or more of those there's a chance that they may have a problem. The gain is another tool that you can use as is the Michigan alcohol screening test or the SASE. So all of those are standardized instruments. Some of them cost money, others like the cage don't. So it may depend on your agency and what kind of budget you've got, what instruments you're using. Any instruments you do use must clearly detail what action should be taken based on received scores. So if a person takes the cage and they say yes to one but not any of the others, does that mean they should be sent for a referral? If they say yes to two, at what point should they be sent for a full assessment? You want to screen, when screening for mental health, you want to screen for acute symptoms such as hallucinations, delusions or depression or anxiety, suicidal thoughts and behaviors, and other mood and thought disturbances. So you're going to ask them about time, place, purpose and person. Do you know what time it is? Do you know where you are? Do you know why you're here? And do you know who I am? And you're going to ask them about short and long-term memory. If they can tell you about something from their childhood, great. But you're also going to ask them if they can tell you about what they had for lunch. Another thing you want to assess or another way to assess short-term memory is to tell them, I'm going to tell you four words and I'm going to ask you in a few minutes to recall those four words for me and then tell them four words, make them easy words like dog, cat, bird and fish, you know, not something that's hard to remember. And then in five or ten minutes, ask them what were the four words I told you and see if they can remember. You're going to ask them about prior involvement in mental health treatment, what worked, what didn't, if they have been in treatment. What prescription medications do they use? And this includes all prescriptions because physical health prescriptions can have mental health side effects. Ask them about recent traumas again, don't get into it but ask them if they've been victimized or experienced any sort of abuse and a family history of mental illness. If they have a family history of mental illness the chances of them developing mental illness are a little bit greater. When screening for mental health, you're going to use the modified mini-screen, the mental status exam, the mini-mental status exam, the brief symptom inventory, a brief psychiatric rating scale, or the symptom checklist 90R. So those are the ones that you're typically going to use. A lot of times they're already in your electronic medical record so you're not going to have to figure out what to use. In terms of, you know, knowing what the instruments are for certification and testing purposes, these are the six that you want to be aware of. So you can Google each one of them and find out more about what each screening test can provide you. Screening is the initial contact to decide if a person may need a more in-depth assessment. Screening is brief but requires the person to be engaged in the process in order to get an accurate result. How well the person is engaged in the screening process is a direct predictor of whether he or she will continue in the process. If you enjoy this podcast please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. 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