Darren Urada, Ph.D. UCLA Integrated Substance Abuse Programs June 26, 2013 Integration Learning...

Darren Urada, Ph.D.UCLA Integrated Substance Abuse Programs

June 26, 2013

Integration Learning Collaborative:Screening Instruments

Today’s Discussion

•Introduction•Alcohol and Other Drug Screen Examples•Mental Health Screen Examples•Two-stage Screening•Combo Screen Examples•Tracking Patient Improvement over time

Introduction

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

Caveat: Survey had a low response rate, screening’s % among all FQHCs may actually be lower.

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

Caveat: Survey had a low response rate, screening’s % among all FQHCs may actually be lower.

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

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

Just because CAGE was reported as most common doesn’t necessarily mean it’s the best instrument to use.

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

Alcohol and Other Drug Screening Instrument Examples

UNCOPE

UNCOPE Plus

Dr. Hoffman

& Alameda

AUDIT

Alcohol Use Disorders

Identification Test

(alcohol only)

AUDIT C+

Alcohol Use Disorders

Identification Test

Plus Illicit Drug Questions

CAGE Alcohol Screen

CAGE-AIDCAGE Adapted to Include Drugs

One YES response indicates a possible problem.Two YES responses indicate a probable problem.Riverside

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.com

CRAFFT(for adolescents)

Sacramento

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

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

Mental HealthScreening Instrument Examples

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.

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).

Two-Stage Approach

• 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

Combination Screening InstrumentExamples

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!

Orange County SBIRT Screening Tool

Mountain Park Behavioral Health Screening Form

*

*

La Clinica de la Raza

Behavioral Health

Screening Form

***

AC-OK Screen for Co-Occurring Disorders

(MH, Trauma and SUD)

By: Andrew L. CherryUniversity of Oklahoma School

of Social Work

For more info:http://faculty-staff.ou.edu/C/Andrew.L.Cherry-1.Jr/AC-CODScreenPg.htm

Universal Screener

(Kern Medical Center)

Tracking Patient Improvement Over Time

• UNCOPE (see previous slide)

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

TEA

LA,Kern (pilot)

Other Issues

• Implementation: who does what, when?• Assessment tools?

CONTACT

Darren Urada, Ph.D.

UCLA Integrated Substance Abuse Programs

durada@ucla.edu