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Screening and Assessment

Integrated Assessment

Individuals who screen positive for co-occurring mental and substance use disorders should receive an indepth, integrated assessment. Integrated assessments gather information and engage individuals in a process that enables the practitioner to establish (or rule out) the presence or absence of a co-occurring disorder.

Integrated assessments:

  • Determine the individual's readiness for change
  • Identify strengths or problem areas that may affect treatment and recovery
  • Engage the individual in the development of a treatment relationship

Assessment is an ongoing process that should be repeated over time to capture the changing nature of the individual's status as he or she moves through recovery.

Effective assessments are a partnership

The goal of an assessment is to gather information to define the nature of that problem. Assessments inform treatment planning and how services are delivered. For this reason, integrated assessments should be conducted in partnership with individuals seeking treatment within the context of a strong therapeutic relationship. Effective assessments are centered on the individual's understanding of his or her problem(s) and his or her goals.

Integrated assessment addresses both mental and substance use disorders, each in the context of the other disorder. There are 12 specific steps in the assessment process. Through these steps, the assessment seeks to:

  • Obtain a chronological history of symptoms and treatment for both mental and substance use disorders.
  • Obtain a description of current strengths, supports, limitations, and cultural barriers that will impact treatment.
  • Find out what the individuals want, what they want to change, and how they think that change will occur.
  • Establish formal diagnoses, evaluate level of functioning to understand the impact on treatment, and determine readiness for change.
  • Make initial decisions about appropriate care.

Integrated assessments consider:

  • Cultural and linguistic issues,
  • Amount of social support,
  • Special life circumstances (e.g., women with children),
  • Medical conditions (e.g., HIV/ AIDS, tuberculosis) that may affect service choices

Assess using multiple approaches

An assessment includes gathering information in many ways. Assessment instruments help practitioners gather standardized information and establish scores that define problem areas. They may also help practitioners remember to cover all relevant areas. There is no single gold standard assessment tool for co-occurring disorders.

Assessment instruments provide information that is one part of the assessment process. They do not themselves constitute an assessment. For example, instruments may not:

  • Make the individual feel welcome
  • Engage the individual as an active partner in his or her care
  • Begin the therapeutic alliance

In addition to the assessment instruments, the assessment process may include:

  • A clinical examination of the functioning and well-being of the individual
  • An in-depth interview
  • A social and treatment history
  • Interviews with friends and family (with permission)
  • a review of medical and psychiatric records
  • a physical examination
  • laboratory tests

A diagnosis is established by referral to a psychiatrist, clinical psychologist, or other qualified healthcare professional.


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