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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 [email protected].
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?
