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Annex B

Screening Tools

1. Identification of Alcohol Misuse. AUDIT;
2. Identification of Drug Misuse. DAST-10;
3. Mental Health Screening (i) GHQ-12 and (ii) HADS (not yet attached);
4. ARBD. ARBIAS/ SAMH (i) identification checklist and (ii) indicators.

AUDIT ( Alcohol Use Disorders Identification Test)

This questionnaire was developed by the World Health Organization to identify persons whose alcohol consumption has been hazardous or harmful to their health.

Note: some drinks may contain deceptively high quantities of alcohol. For example, a can of high strength lager may contain 3-5 units and a bottle of pre-mixed spirit drink may contain up to 2 units.

Date:_____________________________________

CLIENT NAME:______________________________

SCORE: ___________________________________

DRUG USE QUESTIONNAIRE ( DAST-10)

The following questions concern information about your potential involvement with drugs excluding alcohol and tobacco during the past 12 months. Carefully read each statement and decide if your answer is "No" or "Yes". Then, fill in the appropriate box beside the question.

When the words "drug abuse" are used, they mean the use of prescribed or over-the-counter in excess of the directions and any non-medical use of drugs. The various classes of drugs may include: cannabis ( e.g., marijuana, hash), solvents, tranquilizers ( e.g., Valium), barbiturates, cocaine, stimulants ( e.g., speed), hallucinogens ( e.g., LSD) or narcotics ( e.g., heroin). Remember that the questions do not include alcohol or tobacco.

Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right.

Interpretation (Each "Yes" response = 1)

Drug Abuse Screening Test ( DAST-10). (Copyright 1982 by the Addiction Research Foundation. Used with Permission)

GHQ12

General Health Questionnaire

Name ………………………………………………….

We want to know how your health has been in general over the last few weeks. Please read the questions below and each of the four possible answers. Circle the response that best applies to you. Thank you for answering all the questions.

General Health Questionnaire Scoring

Scoring - Likert Scale 0, 1, 2, 3 from left to right.
12 items, 0 to 3 each item
Score range 0 to 36.

Score vary by study population. Score about 11-12 typical.

Score 15 > evidence of distress
Score 20 > suggests severe problems with psychological distress.

ACQUIRED BRAIN IMPAIRMENT
IDENTIFICATION CHECKLIST

INTRODUCTION

The arbias Acquired Brain Impairment ( ABI) Identification Checklist has been prepared to offer clinicians the ability to screen for the presence of potential acquired brain impairment. It is suitable for use in investigating Traumatic Brain Impairment ( TBI), Alcohol Related Brain Impairment ( ARBI) and Substance Related Brain Impairment ( SRBI). This checklist does not constitute a diagnostic instrument, although it will allow clinicians to decide when more comprehensive assessment (neuropsychological assessment) may be appropriate.

GENERAL GUIDELINES FOR ADMINISTRATION

Assessments should be conducted when the person is not intoxicated or in acute withdrawal, when they are alert and motivated to participate. The presence of acute psychiatric conditions such as untreated or unstable psychosis, clinical depression or bipolar affective disorder will reduce the validity of the assessment. Similarly the presence of serious medical conditions and acute distress may affect data quality. It is important to consider environmental factors when conducting assessments: Keeping noise and other distractions to a minimum is necessary to ensure the respondent can provide as much relevant information as possible. Respondents should be given adequate time to respond to questions, and it may be helpful to return to unanswered questions to allow for delayed recall of events. Keep your language simple and direct. Use of nonjudgmental language and demeanor is vitally important in obtaining valid answers. Do not ask more than one question at a time.

QUESTIONING AND PROBING GUIDE

To ensure accurate reporting when assessing a person's history, be open about the purpose of the assessment, the way in which the information will be used, and in particular what impact the assessment might have on treatment. Where recalling alcohol and substance use is difficult, an alternative method to map use (such as a graphical 'timeline' format) can assist recall. For example, plotting well-remembered events like periods of occupation or accommodation first, and then matching up periods of substance use can increase accuracy of recall. This method can also be used on short time scales by using recent salient events (holidays, birthdays, paydays etc).

• BE INCLUSIVE - Clients may not view a substance (such as benzodiazepines) as a drug and may not mention their use. Ask questions for each type of substance:
• E.g. "Can you tell me how much you usually drink each day? How many sleeping pills do you generally use in a day?"
• Using a 'top-high approach' to capture amounts used can invite more honest reporting.
• E.g. "Would you normally drink more than 15 standard drinks of alcohol a day?"
• You may need to think of several ways to frame a question in order to get the information you need, for example:

QUESTIONS:
Can you recall ever overdosing on {substance type}?
Were you unconscious?,
How long were you unconscious for?
Did an ambulance attend at that time?

PROBE: Have you ever used this drug together { e.g. heroin} with another similar drug (like methadone with pills), and found that you accidentally overdosed as a result?

For Traumatic Brain Impairment ensure that all incidences are recorded for each injury type. Periods of loss of consciousness are vital markers of likely injury and, if possible, confirmation of this information should be sought. 'Hospitalisation' refers only to admissions directly related to the brain injury itself - general admissions should not be recorded.

CONFIRMING RISK FACTORS

Where it is not possible to verify a risk factor via direct questioning it may be useful to seek third party sources of information. A release of information can be sought to obtain

medical records or hospital discharge summaries, ask other agencies or workers involved with the client, their partner or family, Where a risk factor has been confirmed it should be marked using the 'risk factor confirmed box' on this tool, otherwise it is recorded as 'identified'.

The identification of one or more risk factors is sufficient indication of potential ABI to prompt further assessment or consultation.

For more information or enquiries in relation to the arbiasABI Identification Checklist contact arbias, arbias@arbias.org.au .

This checklist has been designed to allow you to explore your client's history for potential risk factors for acquired brain

impairment ( ABI), and in particular alcohol or substance related brain impairment ( ARBI / SRBI). Please note this is a screening tool for the presence of risk factors for ABI, and does not constitute a diagnostic tool. Where you have identified one or more of these risk factors, and particularly if they have been confirmed by file records or third party informants it is recommended that you follow up with a neuropsychological assessment for full diagnosis and recommendations as to rehabilitation or management strategies.

Please contact arbias if you have further questions about ABI assessments, or if you require information or specialized training in alcohol and other substance related brain impairment at: arbias@arbias.org.au .

ACQUIRED BRAIN IMPAIRMENT
IDENTIFICATION CHECKLIST

INTRODUCTION

The arbias Acquired Brain Impairment ( ABI) Identification Checklist has been prepared to offer clinicians the ability to screen for the presence of potential acquired brain impairment. It is suitable for use in investigating Traumatic Brain Impairment ( TBI), Alcohol Related Brain Impairment ( ARBI) and Substance Related Brain Impairment ( SRBI). This checklist does not constitute a diagnostic instrument, although it will allow clinicians to decide when more comprehensive assessment (neuropsychological assessment) may be appropriate.

GENERAL GUIDELINES FOR ADMINISTRATION

Assessments should be conducted when the person is not intoxicated or in acute withdrawal, when they are alert and motivated to participate. The presence of acute psychiatric conditions such as untreated or unstable psychosis, clinical depression or bipolar affective disorder will reduce the validity of the assessment. Similarly the presence of serious medical conditions and acute distress may affect data quality. It is important to consider environmental factors when conducting assessments: Keeping noise and other distractions to a minimum is necessary to ensure the respondent can provide as much relevant information as possible. Respondents should be given adequate time to respond to questions, and it may be helpful to return to unanswered questions to allow for delayed recall of events. Keep your language simple and direct. Use of nonjudgmental language and demeanor is vitally important in obtaining valid answers. Do not ask more than one question at a time.

QUESTIONING AND PROBING GUIDE

To ensure accurate reporting when assessing a person's history, be open about the purpose of the assessment, the way in which the information will be used, and in particular what impact the assessment might have on treatment. Where recalling alcohol and substance use is difficult, an alternative method to map use (such as a graphical 'timeline' format) can assist recall. For example, plotting well-remembered events like periods of occupation or accommodation first, and then matching up periods of substance use can increase accuracy of recall. This method can also be used on short time scales by using recent salient events (holidays, birthdays, paydays etc).

• BE INCLUSIVE - Clients may not view a substance (such as benzodiazepines) as a drug and may not mention their use. Ask questions for each type of substance:
  E.g. "Can you tell me how much you usually drink each day? How many sleeping pills do you generally use in a day?"
• Using a 'top-high approach' to capture amounts used can invite more honest reporting.
  E.g. "Would you normally drink more than 15 standard drinks of alcohol a day?"
• You may need to think of several ways to frame a question in order to get the information you need, for example:

QUESTIONS: Can you recall ever overdosing on {substance type}?
Were you unconscious?,
How long were you unconscious for?
Did an ambulance attend at that time?

PROBE: Have you ever used this drug together { e.g. heroin} with another similar drug (like methadone with pills), and found that you accidentally overdosed as a result?

For Traumatic Brain Impairment ensure that all incidences are recorded for each injury type. Periods of loss of consciousness are vital markers of likely injury and, if possible, confirmation of this information should be sought. 'Hospitalisation' refers only to admissions directly related to the brain injury itself - general admissions should not be recorded.

CONFIRMING RISK FACTORS

Where it is not possible to verify a risk factor via direct questioning it may be useful to seek third party sources of information. A release of information can be sought to obtain

medical records or hospital discharge summaries, ask other agencies or workers involved with the client, their partner or family, Where a risk factor has been confirmed it should be marked using the 'risk factor confirmed box' on this tool, otherwise it is recorded as 'identified'.

The identification of one or more risk factors is sufficient indication of potential ABI to prompt further assessment or consultation.

For more information or enquiries in relation to the arbiasABI Identification Checklist contact arbias, arbias@arbias.org.au.

This checklist has been designed to allow you to explore your client's history for potential risk factors for acquired brain

impairment ( ABI), and in particular alcohol or substance related brain impairment ( ARBI / SRBI). Please note this is a screening tool for the presence of risk factors for ABI, and does not constitute a diagnostic tool. Where you have identified one or more of these risk factors, and particularly if they have been confirmed by file records or third party informants it is recommended that you follow up with a neuropsychological assessment for full diagnosis and recommendations as to rehabilitation or management strategies.

Please contact arbias if you have further questions about ABI assessments, or if you require information or specialized training in alcohol and other substance related brain impairment at: arbias@arbias.org.au .

WHAT IS ALCOHOL RELATED BRAIN DAMAGE ( ARBD)?

ARBD is a term used to describe the physical injury to the brain sustained as a result of excessive alcohol consumption. Having ARBD is not the same as having an intellectual disability, nor is it the same as having dementia.

SIGNS TO LOOK FOR IN IDENTIFYING POSSIBLE ARBD

This information provides some practical hints to help workers answer the question "How do we know if someone has ARBD?". Symptoms in the early stages may be subtle and can be difficult to recognise. Mild ARBD in particular is best identified by a neuropsychological assessment.

WHEN IS ARBD MOST LIKELY TO BE APPARENT?

The frontal lobe functions of the brain and the ability to learn new information are essential to coping with and adapting to change effectively. The person with ARBD may attempt to compensate by avoiding change, or may become distressed by it. 'Change' can be as minor as disruption to the daily routine, or may involve starting a new job. Other examples of times where ARBD may become apparent follow:

• Change in worker, carer or staff member
• Change in duties or responsibilities at work
• Retirement
• Relationship break up or problems
• Moving house
• Change in banking procedures
• Moving the furniture
• Loss of a family member or friend
• Disruptions to the daily routine like cancelled appointments
• Last-minute changes to plans
• An unexpected bill
• A new flat-mate

INDICATORS OF ARBD

Clues about ARBD can be gathered by observing the person's mood, behaviour, daily functioning and coping skills. Here are some examples of common indicators:

• Mood changes - anxiety, agitation or depression
• Behavioural changes - behaviour which is difficult or inappropriate, acting out, suspicious or paranoid behaviour, withdrawal
• Confusion and disorientation
• Talking excessively about, and living in, the past
• Problems carrying through with plans and getting around to chores
• Disconnection of gas, electricity or the phone
• Missed appointments
• Repetitious conversation
• Problems staying focused in conversation
• Resistance to change
• Tendency to fabricate missing memories
• Irrational reasoning
• Inability to change even when the person desires to

These symptoms will help you identify people who may require assessment for ARBD.

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