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Counselors should be aware that although a client speaks English relatively well, she still may have trouble understanding assessment tools in English. Scores range from 0 to 5 points. The assessment process should extend beyond the initial assessment. Has anyone used restraints on you to keep you from getting out of bed or out of your wheelchair? The four T-ACE questions see T ­ ACE textbox take less than 1 minute to ask. W-2s are available to view and print beginning in mid-January -- approximately fifteen days earlier than W-2s mailed via the U. Note: While formal assessment tools are consistently used in research associated with substance use disorders, treatment providers and counselors are less likely to use formalized tools and more likely to only use clinical interviews. In response to the need for increased alcohol screening among pregnant women, researchers have developed several alcohol-screening instruments specifically for use with this population. Since women are more likely to experience greater consequences earlier than men, using an instrument that highlights specific consequences of use is crucial. Investigators have sought to retain the fundamental structure of ASI while expanding it to include family history and relationships, relationships with partners, responsibilities for children, pregnancy history, history of violence and victimization, legal issues, and housing arrangements. General mental disorder screening instruments Symptom screening involves questions about past or present mental disorder symptoms that may indicate the need for a full mental health assessment. The Difference Between Screening and Assessment The purpose of screening is to determine whether a woman needs assessment. Clinics Perinat 18 l :93-111, 1991. It includes an excellent tool for helping the counselor determine the risk of harm ; See for specific information on the LOCUS. T-ACE T Tolerance: How many drinks does it take to make you feel high? Have you developed strategies to target their specific obstacles? However, approximately 20 percent of women drink some alcohol during pregnancy, and the rate of frequent drinking i. In general, a positive screen does not indicate an alcoholism diagnosis; rather, it may signal to a physician or other health care practitioner the need to discuss pregnancy risk drinking with a patient. This helps strengthen your processes and provides efficiencies. Brief screenings are used to identify clients who are more likely to have were not normal and were abusive. Conclusion: T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. Screening for Tobacco Use Similar to other substances, women pay an exceptional price for using tobacco. Note: It is important to assess for interpersonal violence in heterosexual and homosexual relationships. Data from a sample of 361 mothers suggest that women who report drinking more than 1. The AUDIT takes about 2 minutes to administer. Some patients will ask for help; others will admit they used drugs — but only before they knew they were pregnant. While research has concluded that the CAGE instrument has similar reliability and concurrent validity among lesbian and heterosexual women, very few studies have addressed the issue of validity and reliability in screening and assessment tools for lesbians. Therefore, alcohol-screening-instrument cutoff scores i. Some patients will ask for help; others will admit they used drugs — but only before they knew they were pregnant. Only biopsychosocial and cultural issues that are pertinent to women were included in the list below. Weeks, who is also medical director of the Norton. It covers several areas for which to screen, such as acute safety risk, mental disorders, sexual victimization, trauma, and eating disorders. The widely used American College of Obstetricians and Gynecologists ACOG Antepartum Record poses three questions about alcohol use: 1 the amount of alcohol consumed per day before pregnancy, 2 the amount of alcohol consumed per day during pregnancy, and 3 the number of years of alcohol use. Selection of screening and assessment instruments should be examined to determine if they were developed using female populations. If a client has symptoms of withdrawal, formal withdrawal scales can be used by trained personnel to gather information to determine whether medical intervention is required. A simple and brief questionnaire to help circumvent denial and underreporting of heavy drinking by pregnant women is the T-ACE. The focus of the program is quick access and stabilization. The focus of the assessment may vary depending on the program and the specific issues of an individual client. The scale has five categories, from minimal risk of harm to extreme risk of harm. In one study focused on sensitivity and specificity of screening questions for intimate partner violence, concluded that when three simple screening questions were used together, identification of lifetime interpersonal violence was effectively identified for women. Two other useful scales are the Acculturation Rating Scale for Mexican Americans II ARSMA; and the Oetting and Beauvais Questionnaire, available at , which assesses cultural identification for Caucasian Americans, Hispanics, American Indians, and African Americans. For some women, drugs have had a secondary effect and purpose, i. While research has concluded that the CAGE instrument has similar reliability and concurrent validity among lesbian and heterosexual women, very few studies have addressed the issue of validity and reliability in screening and assessment tools for lesbians. Counselors should be aware that although a client speaks English relatively well, she still may have trouble understanding assessment tools in English. Cognitive and learning disabilities Prior to screening and assessment, the counselor should inquire about current or past difficulties in learning, past participation in special education, a diagnosis of a learning disability, prior involvement in testing for cognitive functioning or learning disability, and problems related to self-care and basic life management skills. Brief screening is paramount in not only establishing past or present traumatic events but in identifying PTSD symptoms. If you are a current state employee or contract worker and have not received an ACE User ID and Password, contact your agency Personnel or Payroll Officer, or call the MMRS Call Center at 601-359-1343. Overall, individuals who have suicidal or aggressive impulses when intoxicated are more likely to act on those impulses; therefore, determination of the seriousness of threats requires a skilled mental health assessment, plus information from others who know the client very well. CAGE CAGE asks about lifetime alcohol or drug consumption see. Three screening instruments for use with pregnant women are TWEAK, T-ACE, and 5Ps Plus ;. Women may be less likely to have problems with alcohol or drugs than men , ; however, when women have substance use disorders, they experience greater health and social consequences. After Norton MOST Program participants are evaluated and stabilized, the program refers the women for continuing obstetrical care. This understanding begins during the screening and assessment process, which helps match the client with appropriate treatment services. While numerous screening tools are available, information about the reliability and validity of these instruments with women is limited. For example, primary care providers are much less apt to ask private middle-income patients about their use of drugs. Assessing Risk of Harm to Self or Others Suicidal attempts and parasuicidal behavior nonfatal self-injurious behavior with clear intent to cause bodily harm or death; are more prevalent among women. Therefore, a negative finding on abuse at an intake screening should not be taken as a final answer. T-ACE Obstetrics, substance abuse An abbreviated 4-question test that '…circumvents the problems of denial and underreporting that historically make self-reporting—of alcohol abuse during pregnancy…of limited value… it has the further advantage of not seeming to pry into current drinking habits, which might prompt untruthful answers. The T-ACE II + system is a flexible, automated blood component extractor that helps standardize processing of centrifuged blood in accordance with good manufacturing practices GMP. Taking a heavy-handed approach with one patient — telling her to go into treatment or face child protective services — likely will be counterproductive, according to Dr. It is beyond the scope of this chapter to provide specific assessment guidelines or tools for other disorders outside of substance-related disorders. Many immigrant women have little experience with American medical care and do not understand the assessment process. How screening is conducted can be as important as the actual information gathered, as it sets the tone of treatment and begins the relationship with the client. Did you prepare and train staff? The EAT-26 , or Eating Attitudes Test, is a widely used screening tool that can help identify behaviors and symptoms associated with eating disorder risk. At times, clients with PTSD just want to gain relief; they disclose too much, too soon without having established trust, an adequate support system, or effective coping strategies. Specifically, if the woman scores at or above a cutoff score of 20 on the EAT-26, she should be referred for a diagnostic interview. Regardless, it remains important to identify and address any drinking during pregnancy to reduce the risk for fetal alcohol effects. He then encourages the patient to come in to talk more. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. The specificity of a screening test is the probability that a person who should test negative, does so i. Substance Abuse Treatment: Addressing the Specific Needs of Women. The Mini-International Neuropsychiatric Interview M. Little evidence exists to recommend one screening method over another, so clinicians can choose the method that best fits their preference, the specific population of women, and the setting. While treatment program staff may have limited time or feel pressure to conduct initial psychosocial histories quickly, it is important to portray to clients that you have sufficient time to devote to the process. The term pregnancy risk drinking i. Self-administered questionnaire for structured psychosocial screening. Such perceptions have led to failures to diagnose drug or alcohol abuse in pregnant middle- and upper-class women, with tragic consequences for their infants. One point is given for each affirmative answer to the A, C, or E questions. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Poor nutrition and smoking also contribute to obstetrical complications in babies born to mothers abusing opioids during pregnancy. In particular, women entering substance abuse treatment programs should be referred for mental health, medical, and dental examinations. An example of an instrument that can detect symptoms of anxiety is the 21-item Beck Anxiety Inventory BAI; ;. To conduct a good quality assessment, counselors need to value and invest in the therapeutic alliance with the client. The T-ACE is positive with a score of 2 or more points. Little evidence exists to recommend one screening method over another, so clinicians can choose the method that best fits their preference, the specific population of women, and the setting. The assessment interview is the beginning of the therapeutic relationship and helps set the tone for treatment. It correctly identified 69 percent of the "risk drinkers" defined as those consuming 1 ounce of absolute alcohol per day, equivalent to two standard drinks per day out of a cohort of 971 pregnant women. A cutoff score of 2 indicates the likelihood of risk drinking. TIPs that provide assessment information relevant to women in specific settings TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, 2005 TIP 44 Substance Abuse Treatment for Adults in the Criminal Justice System, 2005 TIP 45 Detoxification and Substance Abuse Treatment, 2006 TIP 49 Incorporating Alcohol Pharmacotherapies Into Medical Practice, 2009b Additional TIPs that address assessment strategies and tools for co-occurring disorders and interpersonal childhood and adult violence that are highly prevalent among women: TIP 25 Substance Abuse Treatment and Domestic Violence, 1997 TIP 36 Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues, 2000 TIP 42 Substance Abuse Treatment for Persons With Co-Occurring Disorders, 2005 TIP 50 Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment, 2009a Planned TIP, Substance Abuse and Trauma, in development h Barriers to Treatment and Related Services: Explore financial, housing, health insurance, child care, case management, and transportation needs; discuss other potential obstacles the client foresees. Health Assessment and Medical Examination Because women develop serious medical problems earlier in the course of alcohol use disorders than men, they should be encouraged to seek medical treatment early to enhance their chances of recovery and to prevent serious medical complications. Ann Int Med 116 12 :1032-1032, 1992. Crane Manufacturing Ace Industries Inc. Asking these two questions may be as effective as using longer instruments. ACE access is restricted to current state employees and contract workers who possess a valid ACE User ID and Password. Many standardized instruments and interview protocols are available to help counselors perform appropriate screening and assessment for women. Scales also have been developed for Asian-American groups. Weeks recommends a phone call. The Brief Symptom Inventory is a research tool that can be adapted for use as a screening checklist. It is not adequate to simply translate items from English into another language. The researchers administered both the MAST and CAGE as well as asked the T-ACE tolerance question, “How many drinks does it take to make you feel high? Weeks does a confirmatory test in patients with no prior history to rule out false positives. Pediatrics 89 3 :433-436, 1992. Using psychometrically sound instruments can offset clinical bias and provide more credibility with clients. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire s with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. The acute and chronic effects of alcohol and drug abuse, the potential for violence, and other physical hardships e. Because of the potential adverse consequences of prenatal alcohol exposure, short screening questionnaires are worthwhile preventive measures when combined with appropriate followup. ” The T-ACE was not administered as an independent instrument; instead, both the sensitivity and specificity of the T-ACE were calculated from the subjects responses to the tolerance question as well as to the annoyed, cut-down, and eye-opener questions from the CAGE questionnaire. The most frequent points of entry from other systems of care are obstetric and primary care; hospital emergency rooms; probation officer visits; and social service agencies in connection with housing, child care, and domestic violence. In response, researchers have developed several simple alcohol-screening instruments for use with pregnant women. It is based in part on Diagnostic Interview Schedule and refers to Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition, Text Revision DSM-IV-TR; criteria for substance abuse and dependence. The specificity of a screening test is the probability that a person who should test negative, does so i. Read on to learn more about the various types of cranes we provide. This instrument can be given as a self-administered test, or the questions can be read aloud. This version, the 5Ps, is shown in. Overall, individuals who have suicidal or aggressive impulses when intoxicated are more likely to act on those impulses; therefore, determination of the seriousness of threats requires a skilled mental health assessment, plus information from others who know the client very well. However, if the criterion for the tolerance question is reduced to two drinks for women, the sensitivity of TWEAK increases, and the specificity and predictive ability decrease somewhat. While selection of the instrument may be based on various factors, including cost and administration time , the decision to use an interview versus a self-administered screening tool should also be based upon the comfort level of the counselor or healthcare professional Arborelius and Thakker 1995; ; ;. Be aware that weight gain during recovery can be a concern and a relapse risk factor for women and that clinical and medical issues surrounding body image, weight management, nutrition, and healthy lifestyle habits are essential ingredients in treatment for women. The "socially correct" answer is not known patients do not feel stigmatized to answer honestly , and tolerance reflects a pattern of drinking. PSH has been found to have satisfactory test-retest reliability i. General symptoms of PTSD include persistently re-experiencing the traumatic event, numbness or avoidance of cues associated with the trauma, and a pattern of increased arousal. Screening and assessment must be approached with a perspective that affirms cultural relevance and strengths. Registrants are automatically registered for subsequent years unless they cancel their registration. Screening tools and procedures in evaluating risk are discussed in depth in TIP 50 Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment. Researchers initially evaluated the T-ACE in a sample of 971 African-American women attending an inner-city antenatal clinic. The specificity of a screening test is the probability that a person who should test negative, does so i. Attention is given to instruments that have gender-specific normative data or are useful in attending to the biopsychosocial issues unique to women. Bulimia nervosa is the most common eating disorder among women in substance abuse treatment, and counselors should become knowledgeable about the specific behavioral patterns associated with this disorder, e. These instruments vary in that they were designed to detect different levels of alcohol use and, therefore, differ in how they define pregnancy risk drinking. Compulsive eating, referred to as binge-eating disorder, is not included as a diagnosis in the DSM. Screening and assessment must be approached with a perspective that affirms cultural relevance and strengths. Often, symptom checklists are used when the counselor needs information about how the client is feeling. Practices such as consulting religious leaders or spiritual healers curanderas, medicine men and attending to spiritual activities including sweats and prayer ceremonies, praying to specific saints or ancestors are common. A version that assesses drug use consequences is also available. Because no universally safe level of alcohol consumption during pregnancy has been identified Stratton et al. Some healthcare providers may fear offending their patients by asking them about their substance use. Approximately 15 percent of women in substance abuse treatment have had an eating disorder diagnosis in their lifetimes. A second complication faced by researchers is that many women alter their alcohol consumption once they learn that they are pregnant. According to new studies, even low levels of prenatal alcohol exposure can negatively affect the developing fetus, thereby increasing the importance of identifying women who drink during pregnancy. Study quality was generally good, but lack of blinding was a common weakness. Counselors can simply screen for tobacco use beginning with current and past patterns of use, including type of tobacco, number of cigarettes smoked per day, frequency of use, circumstances surrounding use, and specific times and locations. We compared the sensitivity and specificity of the T-ACE with the sensitivity and specificity of three other popular methods of screening for alcohol use in other clinical settings: 1 the Alcohol Use Disorders Identification Test AUDIT Babor et al. In a study of more than 3,000 women at a prenatal clinic, the TWEAK was found to be more sensitive than the CAGE and Michigan Alcohol Screening Test MAST , and more specific than the T-ACE. For women, the most frequent points of entry from other systems of care are obstetric and primary care; hospital emergency rooms; social service agencies in connection with housing, child care, disabilities, and domestic violence; community mental health services; and correctional facilities. It provides information about instruments for use by drug and alcohol counselors, primary healthcare providers, social workers, and others. In addition, screening for any alcohol use during pregnancy is difficult. Alcohol use was measured by validated semi-structured interview. However, it was also the least specific. It consists of 10 questions that were highly correlated with hazardous or harmful alcohol consumption. In addition, scientists and clinicians have found that certain neurobehavioral outcomes associated with prenatal alcohol exposure can persist in the affected person into adolescence Sampson et al. Opioid use among pregnant women is common. Upon identification of traumatic stress symptoms, counselors need to refer the women for a mental health evaluation in order to further assess the presenting symptoms, to determine the appropriateness of a PTSD diagnosis, and to assist in establishing an appropriate treatment plan and approach. Interpersonal violence Studies estimate that between 50 to 99 percent of women with substance use disorders have a history of interpersonal violence ;. In one study focused on sensitivity and specificity of screening questions for intimate partner violence, concluded that when three simple screening questions were used together, identification of lifetime interpersonal violence was effectively identified for women. The first question assesses tolerance by asking if it takes more than it used to to get high. Asking these two questions may be as effective as using longer instruments. For a copy of the screening tool and scoring instructions, refer to. Depression, anxiety, eating disorders, and PTSD are common among women who abuse substances. Alcoholism Clin Exp Res 15 6 :991-1000, 1991. Among pregnant women taking opioids, a national survey conducted in 2019 by the Pregnancy Risk Assessment Monitoring System, a project of the CDC and state health departments, found more than 1 in 5 reported misusing the drugs. Several screening tools are available to determine general acculturation level. Three screening instruments for use with pregnant women are TWEAK, T-ACE, and 5Ps Plus ;. It is not adequate to simply translate items from English into another language. Scoring is simple and immediate. Face-to-face screening interviews are not always successful in detecting alcohol and drug use, especially in pregnant women. Copyright, Cost, and Source Issues Copyright; permission needed to publish. Challenging, disagreeing, being overly invested in the outcome, or vocalizing and assuming a specific diagnosis without an appropriate evaluation can quickly erode any potential for a good working relationship with the client. Time Taken Time taken information works in conjunction with the leave balance information. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted. Notably, assessments need to use multiple avenues to obtain the necessary clinical information, including self-assessment instruments, clinical records, structured clinical interviews, assessment measures, and collateral information. Investigators have sought to retain the fundamental structure of ASI while expanding it to include family history and relationships, relationships with partners, responsibilities for children, pregnancy history, history of violence and victimization, legal issues, and housing arrangements. A common criticism of the CAGE is that it is not gender-sensitive—that is, women who have problems associated with alcohol use are less likely than male counterparts to screen positive when this instrument is used. Methods: Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. Identifying women who drink at risky levels during pregnancy poses special challenges, however, particularly because the definition of pregnancy risk drinking has been refined over time. While many States require screening and assessment for women, specific guidelines and specificity in incorporating women-specific areas vary in degree. The specificity of a screening test is the probability that a person who should test negative, does so i. Screening Instruments The screening instruments described in this section were tested in diverse clinical populations and may help identify women using alcohol during pregnancy. These systems are modular in nature, therefore allowing easy expansion and relocation as lifting needs change. In response, researchers have developed several simple alcohol-screening instruments for use with pregnant women. Measurements of spirituality and religiousness Spirituality and religion play an important role in culture, identity, and health practices. Note: It is recommended that a cutoff score of 1 be employed in screening for women. Some healthcare providers may fear offending their patients by asking them about their substance use. The screening protocol details the actions taken after a client scores in the positive range and provides the standard forms for documenting the results of the screening, the actions taken, the assessments performed, and that each staff member has carried out his or her responsibilities in the process. Note: Question 3, concerning binge drinking, should be revised for women to refer to having 4 not 6 or more drinks on one occasion. The sensitivity of a screening test refers to the probability that a person who should test positive, does so i. The sensitivity of a screening test refers to the probability that a person who should test positive, does so i. T-ACE The T-ACE is a 4-item instrument appropriate for detecting heavy alcohol use in pregnant women. Eating disorder screenings are not designed to establish an eating disorder diagnosis but instead to identify the need for additional psychological and medical assessments by a trained mental health clinician and medical personnel. Screening Instruments The screening instruments described in this section were tested in diverse clinical populations and may help identify women using alcohol during pregnancy. Selection of screening and assessment instruments should be examined to determine if they were developed using female populations. Many instruments have been developed to screen for alcohol consumption, and several measures have been adapted to screen for specific drugs. Women are also likely to deny or minimize their drinking during pregnancy out of embarrassment Morrow-Tlucak et al. CAGE and SMAST performed poorly. However, compared with the 13-item Prenatal Alcohol Use Interview, the ACOG Antepartum Record is less successful in identifying prenatal alcohol use. Residential centers may offer medical exams onsite, but outpatient service providers may need to refer patients to their primary care provider or other affordable health care to ensure that each client has a thorough medical exam. Initially, the interviewer should explain the reason for and role of a psychosocial history. Treatment programs can ask community members, professionals, and other treatment staff from culturally diverse communities to assist in tailoring assessment instruments and protocols for their clients. This TIP makes no specific recommendations of screening and assessment tools for women and does not intend to present a comprehensive discussion of this complex topic. Weeks recommends a phone call. Because certain drugs as well as withdrawal symptoms can mimic symptoms of mental disorders, the continual reassessment of mental illness symptoms is essential to ensure accurate diagnosis and treatment planning. As the woman becomes more comfortable, additional information can be gathered and incorporated into the revised assessment. The CAGE-AID CAGE Adapted to Include Drugs modifies the CAGE questions for use in screening for drugs other than alcohol. Acculturation and Language Issues Acculturation level may affect screening and assessment results. Available screening and assessment tools: Language availability p. Since women are more likely to experience greater consequences earlier than men, using an instrument that highlights specific consequences of use is crucial. Progress toward this goal has not yet been reported. GMP is a multi-faceted system designed to minimize the risks involved in processing blood that cannot be eliminated through testing the final product. Nonetheless, specific populations may warrant further assessment and assistance in detoxification, including pregnant women, women of color, women with disabilities or co-occurring disorders, and older women. The following listing, while not exhaustive, individually reviews tools with available gender-specific information. Scales also have been developed for Asian-American groups. It is administered as a semi-structured interview and gathers information in seven domains i. In some cultures, for example, questions about personal habits can be considered unnecessarily intrusive. Differences in literacy level may require that some clients be screened and assessed by interview or that self-administered questions be adapted to appropriate reading levels. TIPs that provide assessment information relevant to women in specific settings TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, 2005 TIP 44 Substance Abuse Treatment for Adults in the Criminal Justice System, 2005 TIP 45 Detoxification and Substance Abuse Treatment, 2006 TIP 49 Incorporating Alcohol Pharmacotherapies Into Medical Practice, 2009b Additional TIPs that address assessment strategies and tools for co-occurring disorders and interpersonal childhood and adult violence that are highly prevalent among women: TIP 25 Substance Abuse Treatment and Domestic Violence, 1997 TIP 36 Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues, 2000 TIP 42 Substance Abuse Treatment for Persons With Co-Occurring Disorders, 2005 TIP 50 Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment, 2009a Planned TIP, Substance Abuse and Trauma, in development h Barriers to Treatment and Related Services: Explore financial, housing, health insurance, child care, case management, and transportation needs; discuss other potential obstacles the client foresees. Anticipation of the test results is stressful and may place the client at risk for relapse. Am J Obstet Gyn 60:863-870, 1989. Sensitivity and specificity are two important properties of every screening instrument. Adverse effects of prenatal alcohol exposure can range from subtle developmental problems, or fetal alcohol effects, to full-blown fetal alcohol syndrome. They are not used to screen for specific disorders, and responses are expected to change from one administration to the next. Weeks, who is also medical director of the Norton. AUDIT The Alcohol Use Disorder Identification Test AUDIT; is a widely used screening tool that is reproduced with guidelines and scoring instructions in TIP 26 Substance Abuse Among Older Adults. The client should not be left alone. Researchers gave each participant the AUDIT and SMAST independently as well as reviewed the participant’ s medical record. The Substance Abuse and Mental Health Services Administration SAMHSA -funded Women, Co-Occurring Disorders and Violence Study includes questions about sexual abuse in its baseline interview protocol, presented in. The standardization of formal assessment measures offers consistency and uniformity in administration and scoring. A service of the National Library of Medicine, National Institutes of Health. TCUDS II is used widely in criminal justice settings. Several of the screening and assessment instruments discussed in this chapter are provided in. No tool is definitive for safety screening. Alcohol use was measured by validated semi-structured interview. Many screening instruments require little or no special training to administer. The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the American Society of Addiction Medicine agree all pregnant women should undergo a screen for drug use. The assessment section includes general principles for assessing women, the scope and structure of assessment interviews, and selected instruments. All assessment staff members should receive training about the cultural and ethnic groups they serve; the appropriate interpersonal and communication styles for effective interviews; and cultural beliefs and practices about substance use and abuse, mental health, physical health, violence, and trauma. If not, counselors need to explore whether or not there are other instruments that may be more suitable to address specific evaluation needs. Depression and anxiety disorders Many formal tools screen for depression, including the Beck Depression Inventory-II , ; ; , the Center for Epidemiologic Study Depression Scale , and the General Health Questionnaire—a self-administered screening test to identify short-term changes in mental health depression, anxiety, social dysfunction, and somatic symptoms —are available. TCUDS II The Texas Christian University Drug Screen II TCUDS II is a 15-item, self-administered substance abuse screening tool that requires 5—10 minutes to complete. With "tolerance" defined as "2 or more drinks to feel intoxicated", the T-ACE was the most sensitive instrument to detect current alcohol consumption, risk drinking, and lifetime DSM-III-R alcohol diagnoses. A cutoff score of 2 indicates the likelihood of risk drinking.
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