From the Substance Abuse and Mental Health Services Administration’s (SAMHSA) – “Treatment Improvement Protocol (TIP) Series” – 2013
Screening and assessment are used to identify a client’s strengths and problems. Normally, screening and assessment occur at intake, and both processes should continue throughout the course of treatment. Routine screening and assessment can identify problems that may arise or manifest after initial intake and can help pinpoint a client’s strengths—such as strong marriage or family ties, strong motivation to change, or the absence of pressing crises. Routine administration of these processes is imperative, as the counselor’s understanding of a client’s strengths and problems significantly influences the type and duration of interventions applied as clients enter treatment in various behavioral health settings.
Screening and assessment are often grouped together, but they are distinct processes. Screening is a formal interviewing and/or testing process that identifies areas of a client’s life that might need further examination. It evaluates for the possible presence of a problem, but does not diagnose or determine the severity of a disorder. For instance, screening a man for substance abuse might entail asking him a few interview questions about drug use and related problems and using a brief screening scale for substance abuse and/or substance dependence. When positive indicators are found, schedule the individual for an assessment.
Assessment is a more indepth evaluation that confirms the presence of a problem, determines its severity, and specifies treatment options for addressing the problem. It also surveys client strengths and resources for addressing life problems. Assessment typically examines not only possible diagnoses, but also the context in which a disorder manifests. A substance abuse assessment, for example, assesses the severity and nature of the substance use disorder and may also explore the possibility of co-occurring disorders; the client’s family, marital, interpersonal, physical, and spiritual life; financial and legal situations; and any other issues that might affect treatment and recovery. Assessment generally involves indepth interviews and the use of various assessment instruments, such as psychological tests.
The Adverse Childhood Experiences (ACE) Study
The Adverse Childhood Experiences Study (ACE Study) is a research study conducted by the American health maintenance organization Kaiser Permanente and the Centers for Disease Control and Prevention. Participants were recruited to the study between 1995 and 1997 and have been in long-term follow up for health outcomes.
The more categories of trauma experienced in childhood, the greater the likelihood of physical health problems, mental health disorders, risk for violence, and early death.
The number of categories was found to determine health outcomes, not the intensity or frequency of a single category.
1.Child physical abuse
2.Child sexual abuse
3.Child emotional abuse
5.Mentally ill, depressed or suicidal person in the home
6.Drug addicted or alcoholic family member
7.Witnessing domestic violence against the mother
8.Loss of a parent to death or abandonment, including abandonment by divorce
9.Incarceration of any family member
I.Diagnoses:youth who meet the criteria for Mental Health Disorder and related symptom manifestation
II.Developmental Functioning: (cognitive, emotional, & behavioral maturity)
III.Contextual Functioning:Individual functioning in relevant life domains, including risk and protective factors, and risk and recovery environments
IV.Safety and Risk Factors: Self and other harm, personal, family, and community safety
Project Competence Longitudinal Study (Masten& Tellegen, 2012)
Harm reduction strategies a designed to reduce or eliminate exposure to conditions (trauma and risk environments) before damaging effects on development can occur.
They also aim to Increase protective influences: For example, parenting that provides both structure and warmth. It also aims to create promotive strategies, which are interventions that target assets or resources to increase potential promotive or compensatory factors.
The thought behind this is that competence begets competence and a clinician (or caregiver’s) goal is to initiate positive developmental cascades, i.e. tailor interventions to susceptibilities or strengths of the person.
As psychiatrist Mark Katz notes, “There’s not anything so wrong with us, that’s what right with us can’t fix.”
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