Integrated Care for drug users: Principles and practice
Guide to choosing assessment tools: Factors to consider
- Primary use: Ensure that the stated use of the tool matches your
requirements. Tools primarily designed for outcome evaluation tend to collect
quantitative rather than qualitative information.
- Ensure that the tool has been validated for use with the target client
group. Some tools have been found to be inappropriate for some client
groups such as prisoners or clients with co-existing mental health problems
(Rome 2002, Type 2/3). Often tools are too broad in their scope to highlight
particular issues synonymous with specific client groups.
- Available assessment instruments for substance users have been designed
with different purposes in mind and vary widely in the time frame they
capture. The assessor will need to be aware of the time frame covered by the
- Similarly assessors should be careful to select a measure sensitive to the
type of substance use involved. Many tools have a focus on opiate injecting
behaviour: the focus and nature of questions within the tool may have limited
relevance to people using non-opiate drugs and who do not inject.
- Many tools provide a composite measure or score of the severity of
substance use. This formula approach, multiplying frequency of use
by amount, might indicate that, by comparison, using cocaine twice
daily is less problematic than using a similar amount of opiate three times
in a day. Assessors will need to be aware of the variance in scoring methods
and how this affects the resulting care provision.
- Assessors should recognise that short periods of abstinence may be
more significant for substances associated with steady use for example opiates
or methadone than for those characterised by binge or episodic use e.g. cocaine.
- The time taken to complete assessment tools ranged from three minutes
to four hours for the tools examined in the assessment tool study (Rome 2002,
Type 2/3). Brief screening instruments tend to take less time to complete
than comprehensive tools. On average, up to 30 minutes appeared to be a reasonable
time to spend on a comprehensive assessment. Specialist or specific assessments,
for mental state assessment or social enquiry report may take longer.
- Administration: tools that require scoring and/or inputting from
paper to computer database will provide additional administrative work for
frontline workers or require dedicated administrative support. Frontline workers
score 61% of commonly used tools. One third of all tools reported in the study
are stored on computer databases (Rome 2002, Type 2/3). The additional administrative
requirements of each tool should be taken into consideration.
- Training requirements: Typically training of one day or less was
required on the use of specific tools (Rome 2002, Type 2/3). Service managers
should ensure that initial training and updates are available to all staff
who would use these tools. Training should include issues regarding the assessment
process and specific guidance on the use of selected tools.
- Developers of new instruments must consider carefully their usefulness across
a number of potential substance use disorders and settings. Before embarking
on developing a new assessment instrument for substance use, careful consideration
should be given to evaluating whether an appropriate one does not already
exist and could be used with no or minor modification for the task in hand.