By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Screening means two different things in drug counseling.
Drug counselors are often required to “screen” clients.
That doesn’t mean they’re looking for reasons to turn people away, but sometimes screening can result in someone not being admitted to the program.
During their career counselors will be called upon to do two very different types of screening.
Both types of screening can be done in mental health systems though I have never heard these things called screening except in substance abuse counseling.
Screening can be used to detect a problem.
Counselors sometimes use “screens” to detect a problem. In medical settings, they might screen for high blood pressure. Drug counselors sometimes set up informational booths or attend public events and ask people a series of questions designed to find out whether that person has a problem with drugs or alcohol.
These kinds of screenings are mostly informational. One common screening tool is the “CAGE” instrument. The CAGE is a series of four questions that can be asked to detect a problem with alcohol. This screen can be administered by the counselor or could be a checklist given the person to be screened. In this screen, a yes to any one of these four questions indicates that the person needs further assessment for a possible alcohol problem.
Because of screenings, people may be referred to their primary care doctor, self-help program, or professional drug treatment.
The second type of screening happens when a drug program admits someone.
People don’t usually show up at the cancer center wanting to try chemotherapy even though they don’t have cancer. People do sometimes turn out for a drug treatment program that doesn’t meet their needs. People who are homeless may try to get into a residential drug program even though they don’t have a drug problem because they need a place to stay and food to eat.
Sometimes a lawyer has told the client they need to get into counseling. Maybe they’re going to court for a DUI or domestic violence charges. They want to sign up for a program, so they have something to show the judge when they go to court. Now if they really have a drug problem that would be appropriate. But if they need an anger management program or domestic violence program, the drug counselor should not be signing them up for drug treatment.
During intake, the counselor will be asking questions to find out if this person has a substance use disorder. Some programs specialize in a particular type of treatment. Someone with an opiate or methamphetamine use disorder would not be appropriate for a drunk driving program.
Some programs are residential; some are outpatient. You don’t want to put someone with a full-time job into a residential treatment program they won’t be able to attend. A man would not be admitted to a women’s only program. If the client does not speak English and you have no staff speaking their language, you either must be able to provide an interpreter or referred them to a program that provides services in their language. You shouldn’t put an adult in a program for adolescents or a teenager in an all adult program.
During intake, the question the counselor is asking themselves is: “Is this client appropriate for our program? Do they have the problem we treat? Are they part of the “population” our program is designed to serve?
If you get no is to any of those questions you won’t be able to admit this client. That does not mean you merely turn them away. Another one of the counselor’s essential functions is to be able to do a thing we call “referrals and linkages” in which you help them access services your agency does not provide. More on that function in another post.
Is this person acceptable to your program?
There might be some reasons why, even though the person has the problem you treat, like drug addiction, and they are part of the population you serve, for example, if this client is a man and your program has groups specifically for men, you may still have to turn them away. Why might someone who is appropriate for your program not be acceptable?
Sometimes this is the question of finances. If you take a specific medical insurance, but the client doesn’t have that kind of insurance, you can’t accept them. If your program is funded by criminal justice, parole or probation but this client was referred by their doctor for a medical problem you might not be able to accept them.
If your program treats women and children, you may not be able to admit the client with a history of convictions for rape or child molestation. A residential drug treatment program may have things in their rules or their insurance requirements that prohibit them from admitting a person with a history of convictions for arson. You must be careful not to create so many rules that you screen out all people in need of treatment, but there may be certain people that you will not be able to admit to your program.
The screening part of intake boils down to two questions.
- Is this client appropriate for the kind of treatment you offer?
- Is this client acceptable under the rules of your program or is there some reason you can’t admit them.
Treatment begins with your first contact with the client.
Sometimes clients call, and sometimes they come in person. From the moment they make the first contact, the whole course of treatment takes shape. This is why it’s crucial for the people at your front desk or who answer the phone to be knowledgeable about your program and to be engaging.
Screening could happen during that first contact even if it’s on the phone or it may take place at your first face-to-face meeting in the office. It’s imperative that if you can’t provide the needed services, you can give them a referral. You may have potential legal liability if someone calls and is suicidal and you don’t refer them for appropriate treatment.
Once the screening is completed, whether it happened on the phone or in person, the next step in the process of getting someone into treatment is the intake. In our next post let’s look at all that paperwork that needs to be done during intake.
For more on the drug counselor domains and the core functions see John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor,
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