Screening and Assessment Protocol

Why and When to Use

Drug and Alcohol Screening Screening can be defined as “a public health service in which members of a defined population, who do not necessarily perceive they are at risk of, or are already affected by, a disease or its complications, are asked a question or proffered a test to identify those individuals who are more likely to be helped than harmed by further tests or treatment to reduce the risk of disease or its complications” (National Screening Committee, 2000).

Generic services that are not drug specific e.g. Emergency Departments, hospitals, social work, and probation and more can all carry out drug and alcohol screening. Service Users should be screened using the evidence based W.H.O. approved screening tools – AUDIT. If they require further support with drug and alcohol issues they will be referred onto a drug or alcohol service. AUDIT and DUDIT are also the screening tools used as part of the Irish national SAOR model of Screening and Brief Intervention.

“Screening should facilitate identification of people with hazardous and harmful alcohol use who require brief, time-limited interventions, and identify those people who need to be referred for more Comprehensive Assessment”

(O’Shea, J., Goff, P. and Armstrong, R. (2017) SAOR: Screening and Brief Intervention for Problem Alcohol and Substance Use (2nd ed). Dublin: Health Service Executive.)

Initial Assessment

All staff who have completed case management training can carry out an Initial Assessment. Generally, this assessment is conducted when first engaging with addiction and homeless services.

Services will undertake an Initial Assessment with all new referrals and self-referrals that do not already have a care plan or Case Manager in place. This will be done within the first two weeks of the Service User making contact with the service. The purpose of the Initial Assessment is to ensure the individual is referred to the correct service, inform a care plan and to ascertain whether they need a Comprehensive Assessment and a Case Manager. It is conducted to determine the seriousness and urgency of the drug and/or alcohol problem and other issues of concern in their lives. Identifying a person’s motivation to engage with treatment and rehabilitation services and any immediate risk factors should happen here. The Initial Assessment also determines if conducting a Comprehensive Assessment is appropriate.

It is important that people understand why they are being asked what they are being asked, as such, a guide to domains in the Initial and Comprehensive Assessment is included later in this manual.

Some questions in the Initial Assessment are aligned to the Health Research Board (HRB) LINK system. (Specific to Drug & Alcohol Services only).

The Service User Information & Consent form should be explained and signed at this Initial Assessment stage. Please become familiar with the Consent and Confidentiality Protocol described earlier and GDPR guidelines explained later in this manual.

Always remember…

1. Without consent there can be no Service User, and as such there can be no case and can be no intervention. Consent must be understood and signed at the start of the Initial Assessment.
2. PASS Database System consent is specific to the homeless service and refers to having Service User data inputted in the homeless services data systems.
3. Additional Consent covers most other possibilities. The need for additional consent may or may not be known at Initial Assessment; the need for additional consents may develop as the care plan progresses.
4. People can withdraw Additional Consent at any stage.
5. Please note that a ‘Plain English’ version of consent is provided on page 3 of the Assessment form.

Comprehensive Assessment

The Comprehensive is an extension of the Initial Assessment so all information on the Initial needs to be up to date. Both are part of the one document.

The Comprehensive Assessment aims to determine the exact nature of the individual’s drug and alcohol use, accommodation requirements and coexisting problems in the other domains of health (mental, physical and sexual), social functioning and offending. A Comprehensive Assessment can be seen as an on-going process rather than a single event. It will identify services that should be involved in an interagency care plan.

Prior to the Comprehensive Assessment being undertaken the Service User will be informed of the consent already agreed upon. The worker will then contact services currently working with individual, to see if a Case Manager/care plan is already in place. Services can add or withdraw agencies named as case progresses with Service User’s consent.

If there is a Case Manager already assigned then two workers and the Service User will meet or it will be agreed over the phone/email (consider data protection) how the agencies will work together to support the care plan.

If no Case Manager exists then the service undertaking the Comprehensive Assessment may take on this role until the most appropriate Case Manager is identified (see glossary for Case Manager).

Of note: The questions marked R 1 – R 10 refer to the risk assessment on page 15 of the assessment. This can be used with Service User consent if requested by another service. As the questions are already asked throughout the assessment there is no need to go through this again with the Service User.