To foster the implementation of integrated approaches for New York State residents with co-occurring mental health and substance abuse conditions.

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Assessment is a bio-psychosocial process that gathers information about a client’s psychiatric and substance use history, and continues to compile an integrated account of strengths, history, current symptoms, any self-reported diagnoses, the stages of change for both disorders, and other pertinent information. Family members and/or others who support the client’s recovery should be encouraged to participate in the assessment process.

Assessment

In July 2008, OMH Commissioner Michael Hogan and OASAS Commissioner Karen Carpenter-Palumbo sent a letter and guidance documents to the Directors of every OMH- and OASAS-licensed outpatient clinic in New York State. The letter and accompanying guidance documents strongly encouraged all outpatient facilities to include specific protocols and practices to improve services for persons with co-occurring mental health and substance use conditions. The assessment guidance documents outline 12 domains of assessment for co-occurring substance use and mental health conditions. CEIC is available to assist providers in reviewing and implementing assessments in all twelve domains.

Key concepts for assessment of co-occurring disorders (COD) include:

1. “No wrong door” – Individuals should be welcomed into treatment wherever they enter and should receive an assessment that addresses all of their needed services. They should be assisted in accessing those services regardless of whether the client is appropriate for the agency service. Each contact with the client should facilitate engagement in ongoing services.
2. Empathy – The counselor expresses empathy for the client and collaborates to achieve the client’s best interests. The clinician recognizes that he or she cannot change the client directly but can work to support the client’s efforts toward change.
3. Person-centered assessment – The client’s perceptions, views, and wishes about achieving positive change are actively sought and considered in the assessment process.
4. Appreciation of racial and ethnic culture, gender, sexual orientation, and/or other group markers – The clinician recognizes the importance of these group markers on the client’s perception of the problem, treatment, and request for help, as well as presentation in the interview. The clinician needs to consider how his or her own group markers shape his or her world view and be willing to engage in a genuine exploration of how the client’s world view was shaped.
5. Trauma sensitivity – There is a high prevalence of trauma in COD populations. Clinicians should recognize the dilemmas that survivors face in seeking help and in forming a therapeutic alliance. Each client should be approached as if he or she has experienced some trauma in the past, and the interviewer should take a non-judgmental, warm, and welcoming stance and sustain emotional safety in the interview.

Each of these concepts is essential to providing an integrated substance use and mental health assessment. Clinicians should take time and use reflective listening; they should allow for exploration with the client and avoid rushing through the interview. Engagement of the client in the session is essential in getting an accurate picture of strengths, problem areas, and a diagnostic impression from which to form the plan of treatment.

Domains of Assessment Outline

The goals and principles statements that guided the work of the New York State Task Force on Co-occurring Disorders included anticipated client and family outcomes related to assessment for co-occurring disorders:

“Clients and families can (1) access care anywhere in OMH and OASAS-licensed programs; (2) receive one evaluation; and (3) learn if they have a co-occurring disorder.”

What follows is an outline of the domains of assessment for co-occurring disorders strongly recommended for inclusion in the assessment protocols of all OMH and OASAS-licensed outpatient clinics.

• Presenting Problem(s)
• Current Symptoms and Functioning
• Background
• Individual History
• Substance Use
• Mental Health
• Medical History
• Mental Status Examination
• Client Perception(s)
• Cultural and Linguistic Considerations
• Supports and Strengths
• Diagnostic Impressions on 5 DSM Axes

CEIC Experience in New York State – Programs tend to admit clients who are stable and whose symptom acuity is low to moderate (for substance abuse clinics, clients’ mental problems are usually in remission). Similarly, programs tend to admit clients whose co-occurring disorder is of low to moderate severity. Almost all programs customarily assess clients for a co-occurring disorder, but that assessment is not routinely linked to a positive result on the screener, or to treatment planning. A formal psychiatric diagnosis, based on a clinical interview, is not always obtained, depending on staff resources and capability, with the greatest impediment being the availability in OASAS clinics of staff qualified to determine formal diagnoses. Information about the co-occurring disorder is generally reflected in the narrative section of the assessment and, when included, is typically updated in progress notes and treatment reviews. Assessment of an individual’s readiness for treatment is often not incorporated.

Letter to the Directors of OMH- and OASAS-licensed clinics

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OMH / OASAS COD documents (all; letter & Assessment guide only)

The Commissioners’ letter and Guidance documents for Co-occurring Disorders sent to the Directors of all NYS OMH- and OASAS-licensed clinics

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OMH OASAS General Guidance for Assessment

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CEIC Clinical Pathways Resource Guide (all; Assessment & Treatment Planning section only)

The entire CEIC Clinical Pathways Resource Guide

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Assessment & Treatment Planning section of the CEIC Clinical Pathways Resource Guide

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