The SASSI and Other Assessment Tools

Diane A. Tennies, Ph.D., LADC

Lead TEAP Health Specialist

June 5, 2013

Learning Objectives• After this presentation, participants will be able

to:– List three reasons why the assessment process is an

effective use of time/resources and consistent with the new PRH

– List commonly available assessment tools that are empirically validated and recommended for use in TEAP

– Administer and interpret the SASSI3/SASSIA2– Begin to develop assessment protocols for their own

TEAP programs

PRH 6.11 R1 (c) • Assessment for identification of students at risk for

substance use problems to include:– Review of Social Intake Form (SIF) or intake

assessment of all students performed by counseling staff within 1 week of arrival

– Formalized assessment measures (e.g., SASSI3 or SASSIA2), and clinical judgment to determine students’ level of risk for substance use

– Collaboration with the Center Mental Health Consultant to determine when a MSWR or medical separation is appropriate and should be recommended for a student with substance use conditions

But Who Do We Assess?

Everyone? Just a few?

Screening• Screening for disease has become a mainstay of today’s

preventive health care. • SBIRT defined:

– Screening for alcohol/drug problems with a validated brief questionnaire

– Brief intervention by a professional who discusses alcohol and drug use issues with those who may be at risk

– Referral to treatment, if warranted• Becoming a recommended best practice.• Increased screening allows clinicians to intervene early

before they become too serious. How does this apply to JC?

What is the screening at JC?

• Alert Questions on JC Health History Form

• Urine toxicology screening• Clinical judgment during interactions• Review of SIF – CRAFFT

– total score– specific items

• Others?

Job Corps Health History Form

• The Job Corps Health History Form (completed within 48 hours of a student’s arrival):– Are you currently feeling stressed out and need to

talk with someone today?* – In the past 2 weeks, have you used alcohol or used

drugs frequently or daily?*

• An affirmative answer these questions may signify a serious problem. A member of the medical and/or nursing team should review all questions on this form with the new student and refer as needed

Reminder – CRAFFT Questions

• C-Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs? **

• R-Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

• A-Do you ever use alcohol/drugs while you are by yourself, ALONE?

• F-Do you ever FORGET things you did while using alcohol or drugs?

• F-Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

• T-Have you gotten into TROUBLE while you were using alcohol or drugs?

• Answers two or more = further assessment required

**Car Question?• This screens for the greatest public

health problem

• Motor vehicle deaths are the leading cause of death among this age group (don’t have to be behind the wheel to die)

When Further Assessment is Needed

• What are the ‘critical elements’?– Multiple data sources– Therapeutic alliance– Increased time and effort with individual focus– Narrow focus to specific issue to assess –

individualized – What else is in your ‘tool bag’?

• What about validity of self-report and how do we enhance?– Reality of drug screening– Review the ‘data’ you have (653; SIF; other info in

SHR)– Motivational Enhancement strategies – examples?

Value of an Assessment Process

• How are ‘high-risk’ students identified in TEAP now?

• Are there better ways to identify and intervene with the higher-risk students?

• What does screening and assessment ‘add’ to TEAP?– Improved identification means improved retention– Early intervention means improved outcomes – Enhanced therapeutic alliance for future

interventions – Utilization of your skills as the ‘addiction specialist’

Assessment Tools Options

• These are well-established with adequate reliability and validity: – MAST– DAST– SASSI-3/SASSI-A2

Michigan Alcoholism Screening Test (MAST)

• One of most widely used measures for alcohol abuse

• 25 items• Paper/pencil or interview formats• Takes total of 15 minutes to administer

and score• Good psychometric properties

Drug Abuse Screening Test (DAST)

• 10, 20, or 28 item versions• Self-report with binary (yes or no

responses)• Face valid*• Modified from MAST• Relatively good psychometric properties

• *A test has face validity if it "looks like" it is going to measure what it is supposed to measure

Substance Abuse Subtle Screening Inventory - 3

• Initially published by G. Miller, Ph.D. in 1988 (initial adolescent version in 1990 for ages 12-18)

• Administered and scored in about 15 minutes• Computer or hand scored• Overall accuracy in distinguishing people with

substance dependence from those without is 94%

SASSI Specifics• One side has face valid items – asks

about frequency of use of drugs/alcohol as well as presence of ‘known’ difficulties related to substance misuse = obvious questions

• True/false side – asks statements which appear unrelated to substance use, such as ‘I have been tempted to leave home.’

Why Subtle Items?• Based on research showing that individuals with

substance dependence diagnosis answered differently than the general population

• Statistical analysis detected a set of questions which substance dependent individuals consistently answered differently

• Not based on a theory of substance dependence• Does not matter why they answered as they did

but rather research has shown that people who answer questions this way have a high probability of a substance dependence disorder

More Specifics• Ten subscales (two face-valid scales and eight

clinical subscales)• FVA (Face Valid Alcohol) – acknowledged use

of alcohol• FVOD (Face Valid Other Drugs) – of other

drugs• SYM – Substance Misuse Symptoms• Causes, consequences and correlates of

substance misuse• RAP – random responding• OAT – obvious attitudes – characteristics

commonly associated with substance misuse

More Specifics (cont.)• SAT – subtle attitudes – basic personal style similar to

substance-dependent individuals• DEF – defensiveness – may or may not be related to

substance misuse, may be either enduring trait or temporary reaction

• SAM – supplemental addiction measure – supplements other scales and not used for clinical interpretation

• FAM – family vs. controls – similarity to family members of substance dependant people

• COR – correctional – similarity to people with extensive legal difficulties

Decision Rules

• FVA 18 or more• FVOD 16 or more• SYM 7 or more• OAT 10 or more• SAT 6 or more• Rule 6 -9 combinations of above

What Happens Next?• Determine the level of risk –

– Putting all the data together– Using clinical judgment to decide level– Is a ‘rating’ of low, medium, or high

possible?

• What is possible range of outcomes?– Brief intervention (using MI strategies) with

everyone– Then consider:

• Offering intervention services • MSWR (in collaboration with CMHC)

Brief Interventions: The Elements

• Three Elements with acronym FLO:– Provide Feedback about assessment results – Ask student for their reaction and views

about their own drug use. Listen carefully to encourage their thinking and decision-making process.

– Provide advice, and negotiate a decision about Options, including establishing a goal and developing an action plan

Document in the SHR

• Need to be efficient• Easily accessible to other Health

and Wellness staff• Options?

Create a Summary Sheet for Rapid Review

Learning Objective - Revisited

1. List three reasons why the assessment process is an effective use of time/resources and consistent with the new PRH– Improved identification means improved retention– Early intervention means improved outcomes – Enhanced therapeutic alliance for future interventions – Utilization of your skills as the ‘addiction specialist’

2. List commonly available assessment tools that are empirically validated and recommended for use in TEAP– MAST– DAST– SASSI’s

Learning Objectives - Revisited

3. Administer and interpret the SASSI3/SASSIA2

4. Begin to develop assessment protocols for their own TEAP programs

• Main:(800) 726-0526• Clinical:(888) 297-2774• Training:(800) 697-2774• Tech Supt.:(888) 251-4147• Email:sassi@sassi.com

Wrapping Up