Effective counseling begins with effective assessment. I think the problem with poor outcomes and low success rates for many alcohol and drug treatment programs starts with how they handle assessments, or how they don’t handle them in many cases. Many years ago, I worked in a treatment center where clients were admitted to the residential facility, started the program, and were often discharged from the program – before they received a complete assessment. One or two clinicians were assigned the task of handling assessments, and they assessed the clients as their schedule permitted. Sometimes weeks or months later, often never. On occasion, clients would make it through the program and graduate without ever being assessed. Counselors would begin counseling clients and wait indefinitely for an assessment to show up in the client’s file. It is a state-licensed treatment facility, that facility still follows the same procedures today.
In private practice, a comprehensive assessment allows me to fully understand the client’s substance use disorder and how to help them achieve success. It is the data that enables me to create a comprehensive recovery plan that specifically addresses the client’s needs. With advancements in technology, it has never been easier to complete a thorough assessment. In my practice, this involves the administration of standardized screening and assessment tools in addition to the bio/psych/social interview. In the past, it took a considerable amount of time and training to administer and score most of the assessment and screening tools. Now you can deliver many of them by computer or the internet and receive the scoring and reports instantaneously.
I use the Substance Abuse Subtle Screening Inventory (SASSI-4) and the Addiction Severity Index (ASI). There are at least 18 other substance abuse screening and assessment tools available, but I prefer these two for several reasons. The SASSI-4 takes a client less than 20 minutes to complete and is one of the most accurate screening tools available. It helps to identify individuals who have a high probability of a substance use disorder and also individuals who are in denial or unwilling to acknowledge their substance abuse problems.
The ASI is one of the most comprehensive assessments and addresses seven potential problem areas that are critical to understanding significant problems that may be contributing to a client’s substance use. The ASI takes the client approximately 90 minutes to complete and automatically generates a narrative report with composite scores, a client placement worksheet based on the six ASAM dimensions, and a treatment planning tool. You can administer both the SASSI-4 and the ASI via an interactive multimedia internet-based version.
Once I have screened a client, and they have completed their intake paperwork, which I send to them electronically, I create profiles for them in both tools and email them the links to complete them online. I instruct them to complete the assessments before their initial appointment, and I review all of the data before the first session. This process allows me to bypass much of the basic information gathering and focus on further understanding the problem areas during the 90-minute assessment session. I share data with them from both tools during the meeting, which can also be helpful for them in understanding the severity of their problem.
One unintended benefit I have discovered over the years is that it also helps to keep the client engaged during the downtime between their initial screening and their first appointment. While it is typically less than one week from the time a client initially contacts me to our first in-person meeting, completing these assessments allows the client to begin engaging in the process immediately. Before our initial meeting, the client has already made an investment of time in their recovery. If a client cannot complete these before the first session, it is often a significant red flag that often results in a referral to a higher level of care.
There are other important reasons why I believe these tools are valuable in private practice. If you are billing insurance, or your clients are submitting superbills for reimbursement, there is always the chance that the insurance company will require additional information for the approval of their claims. They may ask what standardized tools or assessments you used to evaluate their need for counseling. In the unlikely event that questions arise regarding your scope of practice or your assessment procedure, you also have two independent measures of the client’s substance use disorder and the severity. These tools provide data that is independent of your professional opinion. I have also had scenarios where the assessment tools and my interview resulted in a referral to a higher level of care. In some cases, the client was able to utilize this data to obtain preauthorization for IOP or residential treatment.
The SASSI Institute has a website where you can establish an account, purchase licenses, and begin administering the screening tool to your clients. Their website is https://www.sassionline.com/. They provided comprehensive online and in-person training if you are unfamiliar with the administration and interpretation of the instrument. They also offer free “clinical interpretation” services in which they will review a specific report and help you understand it when necessary. Each time you administer the SASSI-4, you will need to purchase a license. Individually purchasing the license for one administration is $12.50, but you can buy licenses in bulk at a significant discount. I include the cost of the tool as part of the fee I charge for an assessment.
Inflexxion is the company that developed the ASI-MV (multimedia version). Inflexxion does not utilize the same licensing model used by many of the assessment tool providers. They charge one flat fee per year for unlimited use of the tool. For addiction professionals in private practice, that fee is usually $500 per year. Inflexxion understands that this fee can be prohibitive for some counselors just starting their practice, and have made a very generous offer to readers of my book Addiction Private Practice: The Definitive Guide for Addiction Counselors and Therapists, and members of APN. You can set up an account and use the tool as much as you’d like ABSOLUTELY FREE for the first year! Visit the Practice Resources page on the APN website under “Assessments” for information on how to set up your free account.
Membership in the Addiction Professionals Network (APN) is free, and we hope you’ll join us!