Transcript Project LINK Home Visiting Tools & Techniques for Substance

PROJECT LINK
TECHNIQUES & TOOLS FOR SUBSTANCE
ABUSE DETECTION
Presented by
Ashley Cole, MA
Project LINK Case Manager
Region Ten Community Services Board
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SUBSTANCE ABUSE Screening Techniques
IN CONDUCTING A SCREENING, THE JOB OF THE
INTERVIEWER IS NOT TO DIAGNOSE AN ADDICTION
PROBLEM, BUT TO:
 DETECT WARNING SIGNS
 HELP THE CLIENT UNDERSTAND THE RISKS ASSOCIATED WITH
DRUG USE
 HELP CLIENTS ACCEPT FURTHER ASSISTANCE AS NECESSARY.
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SUBSTANCE ABUSE Screening Techniques(cont)
NOTE:
 IT IS ESSENTIAL THAT THE CLIENT BE MADE TO FEEL AT EASE AND
AS COMFORTABLE RESPONDING TO THE QUESTIONS AS POSSIBLE.
 IT IS USEFUL TO BEGIN ASKING ABOUT TOBACCO AND ALCOHOL
AND THEN PRESCRIPTION DRUGS BEFORE MOVING ON TO THE
ILLICIT DRUGS.
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SUBSTANCE ABUSE Screening Techniques(cont)
SOME GENERAL GUIDELINES FOR INITIATING A DISCUSSION
ABOUT SUBSTANCE USE ARE:
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DO SO ONLY IN THE CONTEXT OF A RELATIONSHIP BASED ON TRUST AND
MUTUAL RESPECT.
 MENTION THAT THE QUESTIONS ARE PART OF YOUR ROUTINE PROCEDURES.
 ASSURE CONFIDENTIALITY.
 IT MAY BE HELPFUL TO MENTION THAT IN VIRGINIA THE SOCIAL SERVICES
POLICY IS NOT TO REMOVE A CHILD FROM THE HOME SOLELY BECAUSE OF
ALCOHOL OR OTHER DRUG USE BY A PARENT.
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SUBSTANCE ABUSE Screening Techniques(cont)
 MAINTAIN A POSITIVE ATTITUDE AND A RELAXED COMPOSURE.
 PROMOTE AN ATMOSPHERE OF COOPERATION.
 BE ALERT TO CLUES IN A CLIENT’S PHYSICAL, SOCIAL, EMPLOYMENT, OR
FAMILY LIFE.
REMEMBER THAT THE USE OF ALCOHOL AND OTHER DRUGS
OFTEN IMPACTS EVERY ASPECT OF A PERSON’S LIFE.
 NOTICE CLIENT NONVERBAL CLUES:
AN INABILITY TO ESTABLISH AND MAINTAIN EYE CONTACT, STRAINED FACIAL
EXPRESSIONS, DROOPED POSTURE, AND ANXIOUS AND JITTERY MOVEMENTS
CAN PROVIDE YOU WITH INFORMATION ABOUT A CLIENT’S USE OF DRUGS
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SUBSTANCE ABUSE Screening Techniques(cont)
 ASK THE QUESTIONS NON-JUDGMENTALLY.
 BE SENSITIVE TO LEGAL IMPLICATIONS.
 GIVE THE CLIENT TIME TO RESPOND AND TO ASK QUESTIONS OF HER OWN.
REPEAT OR REPHRASE IF NECESSARY; SUGGEST A POTENTIAL RANGE OF
ANSWERS.
 ASK OPEN-ENDED QUESTIONS THAT DO NOT IMPLY ANY RIGHT ANSWER, OR
GIVE AWAY YOUR OWN REACTIONS.
 LET THE CLIENT KNOW THAT YOU APPRECIATE HER WILLINGNESS TO TAKE THE
TIME TO RESPOND TO YOUR QUESTIONS.
 BE ALERT TO SIGNS, SYMPTOMS, AND PATTERNS THAT ARE HIGHLY
CORRELATED WITH SUBSTANCE ABUSE.
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Indicators Correlated with Substance Abuse
 BEHAVIORAL
 PHYSICAL
 HISTORICAL
 MEDICAL
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BEHAVIORAL Indicators
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HISTORY OF CHILD ABUSE AND/OR NEGLECT
INCEST SURVIVOR
HISTORY OF SUICIDE ATTEMPTS, THOUGHTS, OR GESTURES
CITATIONS FOR DRIVING UNDER THE INFLUENCE
HISTORY OF DOMESTIC VIOLENCE
CAR ACCIDENTS
HISTORY OF SUBSTANCE ABUSE IN FAMILY
DEPRESSION
EATING DISORDER
DIFFICULTY CONCENTRATING
IRRITABILITY OR AGITATION
INCONSISTENT STORIES
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BEHAVIORAL Indicators
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WEIGHT LOSS
INAPPROPRIATE BEHAVIOR
SMELL OF ALCOHOL ON BREATH
UNRELIABLE/UNPREDICTABLE BEHAVIOR
MISSED APPOINTMENTS
SLURRED OR STAGGERED SPEECH
FAMILY CHAOS
HISTORY OF ABSENTEEISM
CONFLICTS WITH SIGNIFICANT OTHERS
ONLY PRESENTS A VAGUE HISTORY OF PERSONAL/MEDICAL PROBLEMS
UNEMPLOYMENT OR UNDEREMPLOYMENT
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BEHAVIORAL Indicators
UNSTABLE LIVING CONDITIONS
ERRATIC SCHOOL OR WORK HISTORY
PARTNERS WHO HAVE SUBSTANCE ABUSE PROBLEMS
LACK OF PRENATAL CARE/MEDICAL CARE
ONE OR MORE CHILDREN WITH HISTORY OF DEVELOPMENTAL,
BEHAVIORAL, AND/OR EMOTIONAL PROBLEMS
 CHILDREN IN FOSTER CARE SYSTEM
 PSYCHIATRIC TX AND/OR HOSPITAL ADMISSIONS FOR PSYCHIATRIC
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DISORDERS
 INFANTS WITH LOW BIRTH WEIGHTS
 FREQUENT LAPSES OF MEMORY
 CHILD WHO DIED FROM SUDDEN INFANT DEATH SYNDROME
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PHYSICAL Indicators
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BODY ODOR (ALCOHOL, CHEMICALS, POOR HYGIENE)
NASAL PROBLEMS (SNIFFLING, RUNNY NOSE)
SKIN PALLOR
BURNED FINGERS (PARTICULARLY FINGERTIPS, HANDS)
BLOOD SPATTERS ON CLOTHING, FURNITURE, ETC.
EXCESSIVE USE OF EYE DROPS
EXCESSIVE USE OF BREATH MINTS
BLOODSHOT OR GLASSY LOOKING EYES
TEETH GRINDING
DILATED OR CONSTRUCTED PUPILS
CUTS AND BRUISES
DENTAL ISSUES/BAD BREATH
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PHYSICAL Indicators
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NAUSEA & VOMITING
SLURRED SPEECH
LACK OF COORDINATION
LOSS OF MOTOR CONTROL
NEEDLE MARKS
DRY MOUTH (FREQUENTLY LICKING OF LIPS)
MENTAL CONFUSION
DIZZINESS
TREMORS
UNKEMPT APPEARANCE
TARDIVE DYSKINESIA
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HISTORICAL Indicators
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ALCOHOL OR DRUG-USING PARTNER
ALCOHOL OR DRUG-USING FAMILY OF ORIGIN
MULTIPLE EMERGENCY ROOM VISITS
HIGHER THAN USUAL NUMBER OF PHYSICIAN VISITS
CHILD WITH ALCOHOL/DRUG-RELATED BIRTH DEFECTS
CHILD WITH HISTORY OF NEONATAL WITHDRAWAL SYNDROME
PLACEMENT OF CHILD/CHILDREN OUTSIDE OF HOME
COMPLEX PERINATAL HISTORIES AND/OR OUTCOMES
PSYCHIATRIC TREATMENT OR HOSPITAL ADMISSIONS
AFFECTIVE DISORDERS
INFANTS WITH LOW BIRTH WEIGHTS
CHILD WITH SUDDEN INFANT DEATH SYNDROME
HISTORY OF DOMESTIC VIOLENCE
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HISTORICAL Indicators
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INCEST SURVIVOR
UNSTABLE/UNSUITABLE LIVING CONDITIONS
HOMELESSNESS
CIGARETTE SMOKING DURING PREGNANCY
PSYCHOLOGICAL ISSUES: POOR SELF-ESTEEM, DEPRESSION, GUILT,
SHAME
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ERRATIC SCHOOL OR WORK HISTORY
POOR MEDICAL OR PRENATAL CARE
HISTORY OF CHILD ABUSE OR NEGLECT
PREVIOUS/CURRENT SUICIDE ATTEMPTS
CITATIONS FOR DRIVING UNDER THE INFLUENCE
PREVIOUS/CURRENT CRIMINAL ACTIVITY
PATTERN OF CAR ACCIDENTS
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MEDICAL Indicators
 LIVER DISEASE
 PANCREATITIS
 HYPERTENSION
 NEUROLOGIC DISORDERS
 GASTRITIS, ESOPHAGITIS
 POOR NUTRITIONAL STATUS
 HEMATOLOGIC DISORDERS
 SEROPOSITIVITY FOR HIV
 FREQUENT BACTERIAL INFECTIONS
 ALCOHOLIC MYOPATHY
 SENSORY IMPAIRMENT
 PROBLEMS OF SEPSIS, CELLULITIS
 HEPATITIS
 ABSCESSES
 CUTS AND BRUISES
 SWELLING OF THE HANDS
 OVERDOSES
 WITHDRAWAL EFFECTS
 PULMONARY INFECTIONS
 HAIR LOSS
 ERRATIC MENSES
 POOR DENTAL HYGIENE
 UNKEMPT APPEARANCE
 ANEMIA
 TUBERCULOSIS
 SEXUALLY TRANSMITTED DISEASES
 NO OR POOR PRENATAL CARE
 MULTIPLE ABORTIONS (SPONTANEOUS
AND/OR ELECTIVE)
 TARDIVE DYSKINESIA
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SUBSTANCE USE SCREENING INSTRUMENTS
REMEMBER:
YOU ARE SCREENING,
NOT DIAGNOSING!
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SUBSTANCE USE SCREENING INSTRUMENTS
THE FOLLOWING SCREENING INSTRUMENTS ARE:
EASY TO REMEMBER AND ADMINISTER
TYPICALLY NON-THREATENING
OFTEN VALUABLE IN OPENING UP DISCUSSION ABOUT ALCOHOL AND
DRUG USE
 *THE 4 P’S
 CAGE
 T-ACE
* HTTP://WWW.HEALTHRECOVERY.ORG
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SUBSTANCE USE SCREENING INSTRUMENTS
THE 4 P’S:
ANY WOMAN WHO ANSWERS “YES” TO ONE OR MORE QUESTIONS SHOULD BE
REFERRED FOR FURTHER ASSESSMENT.
 DO YOU CONSIDER EITHER OR BOTH OF YOUR PARENTS TO BE AN
ADDICT OR ALCOHOLIC?
 DOES YOUR PARTNER HAVE A PROBLEM WITH DRUGS OR ALCOHOL?
 HAVE YOU HAD A PROBLEM WITH DRUGS OR ALCOHOL IN THE PAST?
 ARE YOU PRESENTLY USING DRUGS OR ALCOHOL?
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SUBSTANCE USE SCREENING INSTRUMENTS
CAGE:
IF A CLIENT ANSWERS “YES” TO TWO OR MORE OF THE FOLLOWING
QUESTIONS, SHE SHOULD BE REFERRED FOR FURTHER ASSESSMENT.
 C – HAVE YOU EVER FELT THE NEED TO CUT DOWN ON YOUR DRINKING OR
DRUGGING?
 A – HAVE YOU EVER FELT ANNOYED BY OTHERS’ CRITICISM OF YOUR
DRINKING OR DRUGGING?
 G – HAVE YOU EVER FELT GUILTY ABOUT YOUR DRINKING OR DRUG USE?
 E – HAVE YOU EVER HAD A MORNING “EYE-OPENER” TO COUNTER THE
EFFECTS OF HANGOVER OR TO STEADY YOUR NERVES?
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SUBSTANCE USE SCREENING INSTRUMENTS
T-ACE:
IF A WOMAN WHO ANSWERS MORE THAN TWO DRINKS ON THE TOLERANCE QUESTION IS
SCORED 2 POINTS. EACH “YES” TO EACH OF THE ADDITIONAL THREE QUESTIONS GETS A SCORE
OF “1”. A SCORE OF 2 OR MORE IS CONSIDERED A POSITIVE SCREEN, AND THE WOMAN
SHOULD BE REFERRED FOR FURTHER ASSESSMENT.
 T – HOW MANY DRINKS OR HOW MANY DRUGS DOES IT TAKE YOU TO GET
HIGH? (TOLERANCE)
 A – HAVE PEOPLE ANNOYED YOU BY CRITICIZING YOUR DRINKING OR
DRUGGING?
 C – HAVE YOU EVER FELT YOU OUGHT TO CUT DOWN ON YOUR DRINKING
OR DRUGGING?
 E – HAVE YOU EVER HAD A DRINK OR DRUG FIRST THING IN THE MORNING
AS AN “EYE-OPENER” OR TO STEADY YOUR NERVES?