The SASSI and Other Assessment Tools

1. The SASSI and Other Assessment Tools Diane A. Tennies, Ph.D., LADC Lead TEAP Health Specialist June 5, 2013

2. Learning Objectives • After this presentation, participants will be able to: • List three reasons why the assessment process is an effective use of time/resources and consistent with the new PRH • List commonly available assessment tools that are empirically validated and recommended for use in TEAP • Administer and interpret the SASSI3/SASSIA2 • Begin to develop assessment protocols for their own TEAP programs

4. PRH 6.11 R1 (c) • Assessment for identification of students at risk for substance use problems to include: • Review of Social Intake Form (SIF) or intake assessment of all students performed by counseling staff within 1 week of arrival • Formalized assessment measures (e.g., SASSI3 or SASSIA2), and clinical judgment to determine students’ level of risk for substance use • Collaboration with the Center Mental Health Consultant to determine when a MSWR or medical separation is appropriate and should be recommended for a student with substance use conditions

5. But Who Do We Assess? Everyone? Just a few?

6. Screening • Screening for disease has become a mainstay of today’s preventive health care. • SBIRT defined: • Screening for alcohol/drug problems with a validated brief questionnaire • Brief intervention by a professional who discusses alcohol and drug use issues with those who may be at risk • Referral to treatment, if warranted • Becoming a recommended best practice. • Increased screening allows clinicians to intervene early before they become too serious. How does this apply to JC?

7. What is the screening at JC? • Alert Questions on JC Health History Form • Urine toxicology screening • Clinical judgment during interactions • Review of SIF – CRAFFT • total score • specific items • Others?

8. Job Corps Health History Form • The Job Corps Health History Form (completed within 48 hours of a student’s arrival): • Are you currently feeling stressed out and need to talk with someone today?* • In the past 2 weeks, have you used alcohol or used drugs frequently or daily?* • An affirmative answer these questions may signify a serious problem. A member of the medical and/or nursing team should review all questions on this form with the new student and refer as needed

9. Reminder – CRAFFT Questions • C-Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs? ** • R-Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? • A-Do you ever use alcohol/drugs while you are by yourself, ALONE? • F-Do you ever FORGET things you did while using alcohol or drugs? • F-Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? • T-Have you gotten into TROUBLE while you were using alcohol or drugs? • Answers two or more = further assessment required

10. **Car Question? • This screens for the greatest public health problem • Motor vehicle deaths are the leading cause of death among this age group (don’t have to be behind the wheel to die)

11. When Further Assessment is Needed • What are the ‘critical elements’? • Multiple data sources • Therapeutic alliance • Increased time and effort with individual focus • Narrow focus to specific issue to assess – individualized • What else is in your ‘tool bag’? • What about validity of self-report and how do we enhance? • Reality of drug screening • Review the ‘data’ you have (653; SIF; other info in SHR) • Motivational Enhancement strategies – examples?

13. Value of an Assessment Process • How are ‘high-risk’ students identified in TEAP now? • Are there better ways to identify and intervene with the higher-risk students? • What does screening and assessment ‘add’ to TEAP? • Improved identification means improved retention • Early intervention means improved outcomes • Enhanced therapeutic alliance for future interventions • Utilization of your skills as the ‘addiction specialist’

14. Assessment Tools Options • These are well-established with adequate reliability and validity: • MAST • DAST • SASSI-3/SASSI-A2

15. Michigan Alcoholism Screening Test (MAST) • One of most widely used measures for alcohol abuse • 25 items • Paper/pencil or interview formats • Takes total of 15 minutes to administer and score • Good psychometric properties

16. Drug Abuse Screening Test (DAST) • 10, 20, or 28 item versions • Self-report with binary (yes or no responses) • Face valid* • Modified from MAST • Relatively good psychometric properties • *A test has face validity if it "looks like" it is going to measure what it is supposed to measure

17. Substance Abuse Subtle Screening Inventory - 3 • Initially published by G. Miller, Ph.D. in 1988 (initial adolescent version in 1990 for ages 12-18) • Administered and scored in about 15 minutes • Computer or hand scored • Overall accuracy in distinguishing people with substance dependence from those without is 94%

18. SASSI Specifics • One side has face valid items – asks about frequency of use of drugs/alcohol as well as presence of ‘known’ difficulties related to substance misuse = obvious questions • True/false side – asks statements which appear unrelated to substance use, such as ‘I have been tempted to leave home.’

19. Why Subtle Items? • Based on research showing that individuals with substance dependence diagnosis answered differently than the general population • Statistical analysis detected a set of questions which substance dependent individuals consistently answered differently • Not based on a theory of substance dependence • Does not matter why they answered as they did but rather research has shown that people who answer questions this way have a high probability of a substance dependence disorder

20. More Specifics • Ten subscales (two face-valid scales and eight clinical subscales) • FVA (Face Valid Alcohol) – acknowledged use of alcohol • FVOD (Face Valid Other Drugs) – of other drugs • SYM – Substance Misuse Symptoms • Causes, consequences and correlates of substance misuse • RAP – random responding • OAT – obvious attitudes – characteristics commonly associated with substance misuse

21. More Specifics (cont.) • SAT – subtle attitudes – basic personal style similar to substance-dependent individuals • DEF – defensiveness – may or may not be related to substance misuse, may be either enduring trait or temporary reaction • SAM – supplemental addiction measure – supplements other scales and not used for clinical interpretation • FAM – family vs. controls – similarity to family members of substance dependant people • COR – correctional – similarity to people with extensive legal difficulties

22. Decision Rules • FVA 18 or more • FVOD 16 or more • SYM 7 or more • OAT 10 or more • SAT 6 or more • Rule 6 -9 combinations of above

24. What Happens Next? • Determine the level of risk – • Putting all the data together • Using clinical judgment to decide level • Is a ‘rating’ of low, medium, or high possible? • What is possible range of outcomes? • Brief intervention (using MI strategies) with everyone • Then consider: • Offering intervention services • MSWR (in collaboration with CMHC)

25. Brief Interventions: The Elements • Three Elements with acronym FLO: • Provide Feedback about assessment results • Ask student for their reaction and views about their own drug use. Listen carefully to encourage their thinking and decision-making process. • Provide advice, and negotiate a decision about Options, including establishing a goal and developing an action plan

26. Document in the SHR • Need to be efficient • Easily accessible to other Health and Wellness staff • Options?

27. Create a Summary Sheet for Rapid Review

28. Learning Objective - Revisited • List three reasons why the assessment process is an effective use of time/resources and consistent with the new PRH • Improved identification means improved retention • Early intervention means improved outcomes • Enhanced therapeutic alliance for future interventions • Utilization of your skills as the ‘addiction specialist’ • List commonly available assessment tools that are empirically validated and recommended for use in TEAP • MAST • DAST • SASSI’s

29. Learning Objectives - Revisited • Administer and interpret the SASSI3/SASSIA2 • Begin to develop assessment protocols for their own TEAP programs

30. Main:(800) 726-0526 • Clinical:(888) 297-2774 • Training:(800) 697-2774 • Tech Supt.:(888) 251-4147 • Email:sassi@sassi.com

31. Wrapping Up