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Screening and Assessing Adolescents For Substance Use Disorders
Treatment Improvement Protocol (TIP) Series 31

[Figures]

Figure 1-1: Family Members

Figure 1-1
Family Members

Family can include

Biological or adoptive parents, grandparents, aunts, uncles
Brothers and sisters (including half-siblings)
Current foster parent(s)
Former foster parent(s)
Other children placed in current or previous foster homes
A relative or close friend of a foster parent
An incarcerated biological or adoptive parent
An adult, perhaps a teacher or social worker, who is close to the youth
Other members of the traditional "extended" family

Figure 1-2: Screening and Assessment

Figure 1-2 Screening and Assessment
Level	Content	Methods	Sources
Screening	Substance use disorder severity, plus Home life Psychiatric status School status	Short questionnaire Brief interviews	Client Parent(s)
Comprehensive Assessment	Substance use disorder severity, plus Home life Delinquency Physical/ sexual abuse Medical status Learning status Indepth psychiatric status Environmental risks Environmental assets/ strengths Sexual behavior Developmental status Leisure and recreation Family dynamics	Standardized questionnaire Structured interviews Laboratory tests Direct observation Diagnostic tests	Client Parent(s) Archival records Significant others

Figure 2-1: Indicators for Assessment

Figure 2-1
Indicators for Assessment

Substance Use Disorder-Related

Use of substances during childhood or early teenage years
Substance use before or during school
Peer involvement in substance use
Daily use of one or more substances

Psychosocial

Physical or sexual abuse
Parental substance abuse (including driving under the influence/driving while intoxicated)
Sudden downturns in school performance or attendance
Peer involvement in serious crime
Marked change in physical health
Involvement in serious delinquency or crimes
HIV high-risk activities (e.g., intravenous drug use, sex with intravenous drug user)
Indicators of serious psychological problems (e.g., suicidal ideation, severe depression)

Figure 3-1: Assessment Process

Figure 3-2: The Written Report

Figure 3-2
The Written Report

The written report should identify

The conditions/environment at the time of assessment
The severity of the substance involvement
Youth's conceptualization of reasons for substance use
Factors that contribute or relate to the substance involvement
Diagnosis as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth ed.
History of treatment services, including drug treatment and mental health treatment
A corrective action plan to address problem areas
A detailed plan to ensure that the treatment plan is
- Mindful of the adolescent's expressed views and desires in his own words
- Implemented
- Monitored to its conclusion

The written report should be careful to

Not reduce a youth to a test score or label
Emphasize the youth's strengths as well as problems
Capture the range of issues, strengths, and concerns
Integrate previous workups when they indicate progression of symptoms and problems
Not include opinions and descriptions from previous reports without thought and research (remember that the report can follow the youth for years)

The written report should be distributed

In compliance with the confidentiality requirements of 42 C.F.R.
Only with the signed approval of the adolescent (and, in some States, of the parent or guardian), as described in Federal or State laws

The report should

Serve as a basis for linking youths with needed services
Specify treatment placement recommendations
Recommend posttreatment support services

The report should be written so that it can be understood by the adolescent and all parties concerned.

Figure 4-1: Sample Consent Form

Figure 4-1 Sample Consent Form
Consent for the Release of Confidential Information
I, ___________________________, authorize XYZ Clinic to receive (name of client or participant)
from/disclose to ________________________________________ (name of person and organization)
for the purpose of _______________________________________ (need for disclosure)
the following information__________________________________ (nature of the disclosure)
I understand that my records are protected under the Federal and State Confidentiality Regulations and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time except to the extent that action has been taken in reliance on it and that in any event this consent expires automatically on ____________________ unless otherwise specified below. (date, condition, or event)
Other expiration specifications:
_________________________ Date executed
_________________________ Signature of client
________________________ Signature of parent or guardian, where required

Figure 4-2: Qualified Service Organization Agreement

Figure 4-2 Qualified Service Organization Agreement
XYZ Service Center ("the Center") and the _______________________________ (name of the program)
("the Program") hereby enter into a qualified service organization agreement, whereby the Center agrees to provide (nature of services to be provided)
Furthermore, the Center: (1) acknowledges that in receiving, storing, processing, or otherwise dealing with any information from the Program about the clients in the Program, it is fully bound by the provisions of the Federal regulations governing Confidentiality of Alcohol and Drug Abuse Client Records, 42 C.F.R. Part 2; and (2) undertakes to resist in judicial proceedings any effort to obtain access to information pertaining to clients otherwise than as expressly provided for in the Federal Confidentiality Regulations, 42 C.F.R. Part 2.
Executed this ____________ day of _____________________, 199_____ __________________________ President XYZ Service Center [address] __________________________ Program Director [name of program] [address]

Figure 5-1: Types of Screening/Assessment

Figure 5-1 Types of Screening/Assessment
Initial Screening	Risk Assessment	Drug Testing/Urinalysis	Psychosocial Assessment	Comprehensive Assessment
Purposes
To determine emergency needs with respect to supervision, medical, and psychological treatment.	To evaluate suicide potential, whether youth will be detained, level of custody/restrictiveness, likelihood of further delinquency or substance use, or degree of compliance with community supervision.	To determine the recent use of substances for detection, monitoring, and supervision.	Refers to both psychological and social/environmental aspects of a youth's life.	To clarify factors related to onset of problems, describe history and development of problems, assess problem severity, draw diagnostic/treatment implications.
Domains Probed
Acute intoxication/ withdrawal and need for detoxification Suicide risk Potential for violent behavior Other immediate medical or psychological needs	Demographic variables Offense severity and evidence of substance use Delinquency history, severity of past offenses, disposition of prior charges, prior violations of supervision, escape/absconding, and past involvement in community diversion programs Current legal status Substance use disorder history Psychological functioning and motivation Any mitigating or aggravating factors	Use of alcohol, amphetamines, barbiturates, cocaine, cannabinoids, opiates, PCP, other illicit drugs (e.g., steroids)	Demographic and personal history information Substance use disorder history History of delinquent and aggressive behavior Medical status Psychological/emotional status Family relationships Peer relationships/social skills Educational status Vocational status Evidence of physical or sexual abuse Specialized substance use disorder screening Detailed personal, family, and peer history of involvement in the juvenile or adult justice systems¹	Substance use history, diagnosis of dependence and coexisting disorders² Delinquent and aggressive behavior Medical status Psychological and emotional status Family relationships Peer relationships and social skills Educational status Vocational status Physical or sexual abuse Other markers of disturbed functioning (e.g., fire-setting, cruelty to animals).³
¹ The following areas should be addressed within the specialized use screening protocol: (1) motivation to participate in treatment; (2) recognition of a substance problem; (3) substance history, including types and modes of substance abuse, quantity and frequency of use, and patterns of recent use; (4) HIV risk behaviors associated with substance abuse; (5) current substance problem severity and intensity, diagnosis of chemical dependency, and level of treatment services required; (6) the association between substance use disorders and delinquent behavior (offenses committed while under the influence of substances, and offenses committed to obtain substances); (7) prior involvement in substance use disorder treatment, including the type and location of services, and responses to treatment.
² A diagnosis of coexisting disorders (also known as "dual diagnosis") refers to a situation in which a person has been diagnosed as having a mental health problem in addition to a substance use disorder.
³ Other markers of disturbed functioning may include: (1) history of running away from home and truancy; (2) evidence of stealing, property destruction, and breaking into others' homes; (3) physical cruelty to others, confrontation of crime victims, and use of weapons; (4) initiation of fights and forcible sexual activity with others; and (5) other cognitive and psychological markers (e.g., low frustration tolerance, low self-esteem, irritability, poor modulation of or ability to handle anger).

Figure 5-2: Juvenile Justice Protocols To Implement Screening and Assessment

Figure 5-2
Juvenile Justice Protocols To Implement Screening and Assessment

Initial screening should be done within 24 hours of entry.
Full assessment should be done within several days of entry.
Use of holding cells for screening and assessment is not recommended.
Screening and assessment should follow many of the same guidelines used for youth in the community, such as
- The collection of data from different sources
- The careful selection of the instrument used
The setting in which the interview is conducted is especially important in JJS settings and should be clearly noted in the written record.
Juvenile justice staff should not be exclusively assigned to screening and assessment, as it encourages burnout.
Protocols must be implemented to flag potential suicides.
Protocols are needed to guide JJS staff in responding to critical problems that may arise during screening and assessment, such as
- Reported physical or sexual abuse
- Suicide threats
- Violent or aggressive behavior
- HIV-related concerns
- Symptoms of withdrawal or acute intoxication
Quality assurance monitoring of screening and assessment records should be completed at regular intervals.
Staff must receive adequate training in key areas to handle adolescent-related situations.

Table of Contents

Initiatives | Funding | Home

	U.S. Department of Health and Human Services
	Substance Abuse and Mental Health Services Administration
	Center for Mental Health Services
	Center for Substance Abuse Prevention
	Center for Substance Abuse Treatment

(800) 729-6686

TDD: (800) 487-4889

Español: (877) 767-8432

SAMHSA Home | Freedom of Information Act | Department of Health and Human Services | The White House | USA.gov

Screening and Assessing Adolescents For Substance Use Disorders Treatment Improvement Protocol (TIP) Series 31

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Screening and Assessing Adolescents For Substance Use Disorders
Treatment Improvement Protocol (TIP) Series 31