Where does screening of consumers end and assessment begin? This issue is frequently a topic of debate in the professional literature. Many argue that assessment actually starts the minute the consumer comes into contact with the service system. But as a practical matter, screening, initial assessment and ongoing assessment serve different as well as similar purposes, and also have different components. They are all similar in that:
they require staff with relevant training and competency.
they require staff with basic knowledge about the service system.
they offer an important contact point with consumers.
they require staff with sensitivity to human relations and cultural diversity (such as the necessity of linguistic and cultural competency).
One confusion about the terms of screening, initial assessment and ongoing assessment lies in their relationships to other terms such as intake, referral and triage. Screening and assessment are also easily conflated because both tend to be performed during consumers’ initial access to the service system. In this issue brief, intake and referral are not considered a behavioral health screening, but are viewed as an administrative gathering of data about the appropriateness for a behavioral health referral.
What follows is a sample list of components for each of the three terms, and for each term, a suggested application of credentials.
Screening is intended to gather basic identifying data for an in-depth evaluation. Its components may include some of the following:
Determining eligibility for services and verifying existing diagnosis, if any.
Gathering additional socio-demographic information beyond intake data.
Organizing basic information about presenting problems and issues, and developmental and service history.
Evaluating risk factors for behavioral health, including risk to harm self or others.
Determining level of care.
Assessing natural support system.
Providing follow-up on the referral.
It would appear that these activities can be easily performed by Bachelor’s-level personnel with appropriate training, provided that there are standardized and validated protocols for assessing risk factors and determining levels of care.
Initial assessment is intended to provide a comprehensive evaluation of functioning to assist service planning and intervention, including a comprehensive assessment of functioning status, such as:
Other functioning assessment
Determination of services to help address the condition
Using an example from the Community Partnership of Southern Arizona that is based on state rules, an initial assessment includes:6
CPSA Provider Agency Comprehensive Psycho-social Assessment
Arizona Level of Functioning Assessment (ALFA) and Service Level Guidelines
Client Assessment Form
Clinical Global Impression (CGI)
Health Status Questionnaire (SF-12)
Good professional judgment about the consumer’s functioning is called for during initial assessment, and this should require the participation of credentialed professionals. However, should assessment tools be standardized – even computerized – the workload of credentialed professionals can be lessened. In fact, it is not unreasonable to argue that the gathering of information needed for initial assessment can be performed by personnel with adequate in-service training and supervision by credentialed professionals, even though those personnel might not have behavioral health credentials themselves.
Ongoing assessment beyond initial assessment is intended to assist the treatment process and determine service outcomes. Its components may minimally include the following:
In-depth assessment over time beyond initial assessment (especially when the condition was unstable during initial assessment or there are questions about co-occurring disorders).
Development of treatment plan.
Interdisciplinary team review of progress.
Periodic review of treatment outcomes.
It is clear that at the stage when consumers are involved in treatment, more than one discipline is needed to review treatment progress and determine treatment outcomes. Here, credentialed professionals work in unison with other professionals, as well as consumers and families, toward achieving the goals of recovery and rehabilitation.
To summarize up to this point:
The screening function can be standardized and administered by non-credentialed personnel with appropriate in-service training.
The initial assessment function can also be standardized in order to be administered by staff (with input from consumers and families), with credentialed staff responsible for its interpretation for diagnoses and evaluation. Already in many jurisdictions, mental health and substance abuse screening and assessment formats have been standardized to allow for easy administration and electronic data exchange.7 Moreover, computer software is becoming more readily available and accessible for timely exchange of clinical information, which in turn promotes continuity of care.8
Ongoing assessment beyond the initial assessment as part of the process of service delivery is a responsibility shared by multiple teams and responsible personnel.
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