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Competency 2: Integrated Screening for Co-Occurring Disorders

Skill 2A: Ability to identify the purpose and the key components of conducting a screening.

  • Understand that screening is the process by which the counselor, the client, and available significant others review the current situation, symptoms, and other available information to determine the most appropriate initial course of action, given the client’s needs and characteristics and the available resources within the community (SAMHSA).
  • Understand that screenings are an early and ongoing process that identifies individuals at risk for developing social and health problems and promotes overall health.
  • Understand the importance of screening across multiple health domains and social-service needs because individuals with co-occurring disorders are at high risk for many additional problems, such as financial problems, social isolation, family problems, homelessness, sexual and physical victimization, incarceration, and serious medical illnesses.
  • Understand that screening is often is the initial contact between an individual and the treatment system, and the client forms their first impression of treatment during screening and intake.
  • Understand the importance of rapport building, while balancing the need to obtain information about many aspects of the individual’s life.
  • Understand that a successful and engaging screening can lead to further intervention such as assessment, treatment and monitoring for changes in conditions.
  • Knowledge of the Screening Brief Intervention Referral to Treatment (SBIRT) process.

Skill 2B: Able to detect symptoms and behaviors associated with mental-health and substance-use disorders.

  • Understand that the presence of a co-occurring disorder is always a possibility based on the high prevalence rate in the population. The presence of a co-occurring disorder is treated as the norm rather than the exception.
  • Knowledge of the signs and symptoms of mental-health disorders and substance-use disorders (including problem gambling) that indicate further assessment is needed.
  • Knowledge of the more common mental-health disorders in substance-dependent individuals.
  • Knowledge of the more commonly abused substances.

Skill 2C: Able to screen for mental-health and substance-use disorders (including gambling).

  • Understand the importance of utilizing integrated screening tools that incorporate trauma, cognitive ability, physical health, social needs, and safety risks.
  • When working in a mental-health setting, familiarity with screening tools for substance-use disorders (e.g. AUDIT-C, CAGE, CRAFFT, DAST and SSI-AOD), as well as the use of checklists of substances that include amounts and patterns of use for each.
  • When working in substance treatment setting, familiarity with mental-health disorders screens, for example, Modified-MINI and Mental Health Screen Form III, and the use of psychiatric-symptom checklists that include intensity, duration, and frequency.

Skill 2D: Able to identify trauma-related symptoms and screen for trauma history to determine if further follow up/assessment is needed.

  • Understand that trauma is a risk factor for nearly all mental-health and substance-use disorders and the high prevalence of trauma in individuals with co-occurring disorders.
  • Understand that not addressing trauma can impede successful co-occurring treatment.
  • Familiar with populations who experience trauma at higher rates, such as those in economic distress, military and veterans, those with intellectual and development disabilities, homeless, and LGBQT individuals.
  • Familiar with the range of traumatic events that individuals are exposed to such as bullying, community violence, complex trauma, disaster, medical, physical abuse, intimate partner violence, refugee trauma, sexual abuse, neglect, violence, and traumatic grief.
  • Knowledge of the signs and symptoms associated with trauma which can include intrusive memories, avoidance, arousal, negative changes in thinking and mood, and changes in physical and emotional reactions
  • Understand that responses to trauma can be immediate or delayed.
  • Familiar with trauma-screening tools.

Resources for Skill 2D

Skill 2E: Able to identify common physical-health issues associated with individuals with co-occurring disorders and determine if follow up is needed.

  • Understand the importance of considering the impact of physical health on behavioral health and vice versa.
  • Understand the importance of ensuring individuals are engaged in regular physical health checks and screens.
  • Knowledge of common physical co-morbidities associated with behavioral-health issues, including chronic pain, diabetes, high blood pressure, smoking, heart disease, dental disease, obesity, HIV, Hepatitis, and cancer.
  • Familiar with tools that screen for brain injuries and Understand that brain injuries and possible resulting cognitive impairment, are very common in individuals with co-occurring disorders.
  • Understand that older individuals have an increased risk of significant medical co-morbidity.
  • Understand that many mental-health medications have physical side effects

Skill 2F: Able to screen for common unmet social needs, such as housing instability, inconsistent access to food, and transportation to determine if follow up is needed.

  • Familiar with the unmet social needs commonly associated with individuals with co-occurring disorders.
  • Recognize the positive impact of addressing social needs on an individual’s overall health.

Skill 2I: Able to de-escalate a crisis or high-risk situation and monitor for safety.

  • Understand the steps needed to minimize high risk situations.
  • Knowledge of who to contact within an organization and outside an organization when a crisis emerges.
  • Knowledge of basic de-escalation techniques.
  • Understand how to complete a safety plan.
  • Knowledge of reporting procedures for vulnerable/abused adults and children.
  • Knowledge of the Emergency Petition process.
  • Knowledge of Extreme Risk Protection Orders (ERPO).
  • Understand the importance of receiving Naloxone Training.

Skill 2J: Able to provide helpful resources and referrals for further assessment when various symptoms present.

  • Knowledge of the various resources within an organization and outside of the organization.
  • Understand that coordination of care involves eliciting client preferences, values, and concerns.
  • Understand that the screening and referral process includes monitoring referrals for treatment with the reality that treatment resources may not be readily available.
  • Understand the importance of care coordination to ensure successful access to treatment.

Skill 2K: Able to coordinate care through collaboration with the client, natural supports and other providers to ensure the individual receives appropriate services.

  • Understand that coordination of care involves eliciting client preferences, values, and concerns.
  • Understand that the screening and referral process includes monitoring referrals for treatment with the reality that treatment resources may not be readily available.
  • Understand the importance of care coordination to ensure successful access to treatment.

Skill 2L: Able to assure the inclusion of patient rights, informed care, medical-information protections, mandated reporting, and the importance of information-sharing.

  • Recognize that while screening’s primary goal is to provide education and resources, it might lead to disclosure of reportable information.
  • Knowledge of patient rights, informed care, medical information protections, mandated reporting, and the importance of information sharing.
  • Familiar with organizations confidentiality and consent forms and requirements.