5 Assessment
What is assessment?
Although all the core functions substance abuse counselors carry out are important, assessment is particularly significant. Assessment is the procedure by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of a treatment plan. Global criteria for assessment include:
- Gather relevant history from client, including, but not limited to, alcohol and other drug abuse, using appropriate interview techniques.
- Identify methods and procedures for obtaining corroborative information from significant secondary sources regarding client’s alcohol and other drug abuse and psychosocial history.
- Identify appropriate assessment tools.
- Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding.
- Develop a diagnostic evaluation of the client’s substance abuse and any coexisting conditions based on the results of all assessments in order to provide an integrated approach to treatment planning based on the client’s strengths, weaknesses, and identified problems and needs.
The initial assessment occurs at the beginning of the client’s treatment journey and it usually takes place during the initial visit. However, it’s important to note that assessment is an ongoing process that helps us in evaluating client progress. During the initial assessment, the counselor gathers a thorough client history that includes, but is not limited to:
- Current status of and history related to alcohol and drug use, including any previous treatment
- Current status of and history related to physical health, including any hospitalizations
- Current status of and history related to mental health, including any previous treatment
- Family relationships, including possible issues
- Employment history and career issues
- Current legal status and history of involvement with the legal system
- Emotional and behavioral issues
- Spiritual beliefs, practices, and concerns of the client
- Education and basic life skills
- Strengths the client possesses
- Access to and use of familial and social support
- Access to and use of community resources
- Treatment readiness
- Level of cognitive and behavioral functioning
Resource: Treatment improvement protocol (tIp) 24: A Guide to Substance Abuse Services for Primary Care Clinicians
Information gained through an assessment will clarify the type and extent of the problem and will help determine the appropriate treatment response. Assessment:
- Examines problems related to use (e.g., medical, behavioral, social, and financial)
- Provides data for a formal diagnosis of a possible problem
- Establishes the severity of an identified problem (i.e., mild, moderate, intermediate, or severe stage)
- Helps to determine appropriate level of care
- Guides treatment planning (e.g., whether specialized care is needed, components of an appropriate referral, and eligibility for services)
- Defines a base