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Manual Instruksi Instrumen TEEN ADDICTION SEVERITY INDEX (T-ASI)

 

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TEEN ADDICTION SEVERITY INDEX (T-ASI)

INSTRUCTION MANUAL

Edited by: Yifrah Kaminer, M.D. Oscar G. Bukstein, M.D. Ralph E. Tarter, Ph.D.

Yifrah Kaminer, M.D.

Associate Professor of Psychiatry

Alcohol Research Center

University of Connecticut Health Center

School of Medicine

263 Farmington Avenue

Farmington, CT 06030-2103

ph - (203)-679-4344

fax- (203)-679-4077

[Can be used, but not to be reproduced without authors' permission.]

 

 

TEEN-ADDICTION SEVERITY INDEX

GENERAL INSTRUCTIONS

1. INTRODUCTION

The Teen Addiction Severity Index (T-ASI) is a relatively brief structured interview designed to provide important information about aspects of a patient's life which may contribute to their substance abuse and/or dependence syndrome. It is the first step in the development of a patient profile for subsequent use by research and clinical staff Thus, it is particularly important that the patient and the patient's parents or caretakers perceive the interview as a clinical first step in an attempt to help the patient (Kaminer et al., 1991; 1993).

The T-ASI (1992) is a new modified version of the original ASI developed by McLellan et al. (1980; 1985). McLellan et al. (1992) found after ten years of experience conducting interviews that the ASI, an instrument designed for use with adults, inadequately evaluated adolescents.

The need for development of this instrument, the T-ASI, stemmed from the fact that many adolescents attend school, reside with their parents, do not support themselves, and lack mature (adult) relationships. We have added new questions and categories to include these factors (Kaminer, 1994).

Because adolescents are not always good reporters of time and event, we will also administer the same interview to their parents or caretakers. The instrument will be administered to each separately. Ideally, the adolescent is interviewed first, in order to confirm their information with the parent(s). The patient or adolescent form is referred to as the T-ASI-A and the parental form is referred to as the T-ASI-P. The questions are phrased to address the patient. However, questions should be reworded appropriately, to assess the patient, when interviewing the parent(s).

The interviewer should introduce himself or herself and briefly state that he or she wishes to ask the patient some questions regarding the plan for their treatment. The interviewer should add that these questions are asked of all applicants for treatment, that the interview will be completely confidential and that the information will not leave the treatment setting. Note: This should be re-emphasised throughout the interview.

The trained interviewer should be thoroughly familiar with the structure and content of the interview. First the interviewer should describe the design of the interview, stressing the seven potential problems areas: These areas are: Chemical, School, Employment/Support, Family, Peer/Social, Legal, and Psychiatric. It is important that the interviewer stress the nature of the patient's contribution. For example, the interviewer should state:

"We have noticed that while all of our patients have chemical abuse/ dependence problems, many also have significant problems in other areas such as school, peer, family, etc. In each of these areas, I will ask you how much you have been bothered by problems in this area, and how important you feel treatment (for those problems) is to you. This is an opportunity for you to describe your most important problems; the ones you feel you need the most help with."

The final step of the introduction is the explanation of the patient rating scale (see Section H for specific instructions). This 5-point scale will be used by the patient to answer subjective questions in each problem area and will be presented to him or her for reference at this point in the interview. The interviewer should describe the use of the scale and offer an example to test for understanding by the patient.

As the focus of the interview proceeds from one area to the next, it is important for the interviewer to introduce each section. For example:

"Now I'm going to ask you some questions about your family relationships." Thereby the patient will be prepared to concentrate on each of the areas independently. In this regard, it is important that the patient not confuse problems in a particular area with difficulties experienced in another area---such as confusing psychiatric problems with those due directly to the effects of chemical intoxication.

If a follow-up interview is to be done at some later point, this also should be included in the introduction. For example:

"With your permission, we would like to get back in touch with you six months after you complete treatment to ask you some similar questions. In that way, we hope to evaluate our program and your progress. "

It is expected that by introducing the interview in a clear, descriptive manner, by clarifying any uncertainties, and by developing continued rapport with the patient, the admission interview will produce useful and valid information.

II. PATIENT'S RATING SCALE

It is especially important that the patient develop the ability to communicate the extent to which he or she has experienced problems in each of the selected areas, and the extent to which he or she feels treatment for these problems is important. These subjective estimates are central to the patient's participation in the assessment of their condition.

In order to standardize these assessments, we have employed a 5-point (0-4) scale:

0 - not at all

1 - a little

2 - fair amount

3 - very much

4 - extremely/always

For some patients it is adequate to simply describe the scale and its values at the introduction to the interview and occasionally thereafter. For other patients, it may be necessary to arrive at an appropriate response in a more circumspect fashion. The interviewer's overriding concern on these items is to get the patient's opinion. Getting the patient to use their own language to express their opinion is more appropriate than putting the patient in a position where he or she feels that it is a must to choose a work from the scale.

Several problems with regard to these ratings can occur: For example, the patient's rating of the extent of their family problems should not be based upon their perception of any other problems. The interviewer should attempt to clarify each rating as a separate problem area. and focus the time period on the previous month. Thus, the rating should be made on the basis of the patient's current. actual problems, not potential problems. If a patient has reported no problems during the previous month. then the extent to which he or she has been bothered by those problems must be 0; and the interview should ask clarifying questions such as: "Can I assume then, at this point, that you don't feel the need for any family therapy?" as a check on the previous information. If the patient is not able to understand the nature of the rating procedure, then insert "X" for those items.

III. ESTIMATES

Several questions require the patient to estimate the amount of time he or she has experienced a particular problem in the past month. These items can be difficult for the patient, and it may be necessary to suggest time structuring mechanisms, e.g., fractional periods (one-half the time, etc.) or anchor points (weekends, weekdays, etc.). Finally, it is important that the interviewer refrain from imposing their own response onto the patient. The interviewer should help the patient select an appropriate estimate without forcing particular suggestions.

IV. CLARIFICATION

During the administration of the T-ASI there is ample opportunity for clarification of questions and responses. To insure the quality of the information, be certain that the intent of each question is clear to the patient. Each question need not be asked exactly as stated---use paraphrasing and synonyms appropriate to the particular patient and record any additional information in the Comments sections.

Note: When it is firmly established that the patient cannot understand a particular question that response should not be recorded. Enter an "X" in the first block of that item in these cases. In a case where the patient appears to have trouble understanding many questions, it may be advantageous to discontinue the interview.

V. INTERVIEWER SEVERITY RATINGS

The severity ratings derived by the interviewer on each of the individual problem areas are important to both research and clinical goals. All ratings are based on responses to the objective and subjective questions within each area. Although it is recognized that the interviewer's opinions will affect the severity ratings, and are often important, they introduce a non-systematic source of variation, lowering the overall utility of the scale. In order to reduce this variation, the interviewer must develop a systematic method for estimating severity of each problem. The common use of this standard method will increase the reliability of the severity estimates.

We have established a two-step method for estimating severity. In the first step, the interviewer considers only the objective data from the problem area. Using their objective data, the interviewer makes a preliminary rating of the patient's problem severity (need for treatment) based only upon this objective data. In the second step, the patient's subjective reports are considered and the interviewer can modify the preliminary rating accordingly. However, if a particularly pertinent bit of information that is not systematically collected figures into the derivation of a severity rating, it must be recorded in the "Comments" section. If the patient suggests that he or she feels a particular problem is especially severe, and that treatment is "extremely important" to him or her, then the interviewer may increase the final rating of severity.

For the purposes of this interviewer, severity will be defined as need for additional treatment and will be based upon reports of amount, duration, and intensity of symptoms within a problem area. The following is a description of the ratings:

0 - no real problem, treatment not indicated

1 - slight problem, treatment probably not necessary

2 - moderate problem, some treatment indicated

3 - considerable problem, treatment necessary

4 - extreme problem, treatment absolutely necessary

It is important to note that these ratings are not intended as estimates of the patient's potential benefit from treatment. but rather the extent to which some form o effective intervention is needed. regardless of whether that treatment is available or even in existence. For example, a patient who has committed numerous crimes would warrant a legal severity rating of 4, indicating that it is an extreme problem. A high severity rating is recorded in this case even if no effective treatment is currently available. Patients presenting few problem symptoms or controlled symptom levels should be assigned a low level of problem severity. As amount, duration, and/or intensity of symptoms increase, so should the severity rating. Very high severity ratings should indicate dangerously (to the patient or others) high levels of problem symptoms and a correspondingly high need for treatment.

SEVERITY RATING DERIVATION PROCEDURES

STEP 1: Derive a range of scores (1 or 2 points) which best describes the patient's need for treatment at the present time based on the objective data alone.

STEP 2: Select a point within the range obtained above, using only the information subjective data in that section.

1 . If the patient considers the problem to be less serious and he or she feel treatment is important, select the higher point within the range.

2. If the patient considers the problem to be less serious and he or she considers the need for treatment less important, select the middle or lower rating.

While it is recognized that the criteria for establishing the degree of severity for any problem varies from situation to situation, the above derivation procedures has been found to produce standardized ratings.

Exceptions: In cases where the patient obviously needs treatment and he or she reports no such need, the rating should reflect a need for treatment. The obvious nature of this need must be stressed. Avoid Inferences. Clarify through probes where necessary.

If the patient has reported no recent or current problems, and does report a need for treatment, clarify the basis of his/her rating. The severity rating should reflect no need for treatment, but a note explaining that the patient's rating should be included.

VI. CONFIDENCE RATINGS

The judgment of the interviewer is important in deciding the veracity of the patients statements and their ability to understand the nature and intent of the interview. If the patient's demeanor clearly suggests that he or she is not responding truthfully (e.g., constant, rapid denial) or if there are discrepancies in the data caused by conflicting reports that the patient cannot justify, then the interviewer should indicate a lack of confidence in the information. The confidence ratings are intended to portray the interviewer's judgment on the validity of the information. For example:

Is the above information significantly distorted by:

Patient misrepresentation? no yes

Patient's inability to understand? no yes

Whenever a "yes" response is coded, the interviewer should record a brief explanation in the "Comments" section.

VII. FOLLOW-UP EVALUATION

One of the primary uses of the T-ASI as treatment admission is estimating the pattern and severity of patients' treatment needs for individual patients. Post-treatment adjustment can be measured in the same manner using the T-ASI at the time of follow-up. Comparing an admission T-ASI to a follow-up T-ASI can provide the kind of information required to develop an assessment of treatment effectiveness in terms of net change in a patient's need for treatment.

A few changes in the intake format of the T-ASI are required to make it function as a follow-up interview. Only those questions that have item numbers circled are to be asked at follow-up. AN other questions should be omitted. However, even some of these items are inappropriate for follow-up as stated and require revision. AD items in need of modification are keyed by an asterisk; rewording these questions is necessary to obtain information pertaining only to the follow-up period. This may be done by changing the time frame of those items to "since our first interview" or "since you came into treatment" or "since your date of admission," etc. For reasons of convenience and accuracy, it is recommended that the interviewer firmly anchor the time frame to the period since the client had been previously interviewed. Keep in mind that need-for-treatment questions refer to need for additional treatment, not need for continued treatment.

Important: Using the method described, there is ample evidence that the severity ratings can be both reliable and valid estimates of patient status in each problem area. However, we do not recommend that the severity ratings be used as outcome measures. It is important to remember that these ratings are ultimately subjective and have been shown to be useful only under conditions where all data are available and the interview is in person. This is not always the case in a follow-up evaluation.

VIII. DIFFICULT OR INAPPROPRIATE SITUATIONS

Previous Incarceration or Inpatient Treatment - Several questions within the T-ASI require judgments regarding the previous month or the previous year. In situations where the patient has been incarcerated or treated in an inpatient setting for those periods, it becomes difficult to develop a representative profile for the patient.

Patient's Misrepresentation - We have found that some patients will respond in order as to present a particular image to the interviewer. This generally results in inconsistent or inappropriate responses which become apparent during the course of the interview. As these responses become apparent, the interviewer should attempt to assure the patient of the confidentiality of the data, re-explain the purpose of the interview, probe for more representative answers, and clarify previous responses of questionable validity. If the nature of the responses does not improve, the interviewer should simply discard all data that seems questionable by entering 'W' where appropriate and record this on the form. In the extreme case. the interview should be terminated.

Poor Understanding - Interviewers may find patients who are simply unable to grasp the basic concepts of the interview or concentrate on the specific questions. When this becomes apparent, the interview should be terminated.

SPECIFIC INSTRUCTIONS

Instructions

The instruction section provides general guidelines and procedures used in filling out this form.

Note: It is important to differentiate items which are not applicable to the patient (which should be coded as W), from items that the patient cannotunderstand or will not answer (which should be coded as "X"). Please leave no items uncoded.

Note: Be sure to answer all circled items on the follow-up T-ASI interviews, utilizing the procedures outlined in the Introduction (see Follow-up Procedure).

Rating Scale

Use this rating scale as a reference for the patient when completing the questions that pertain to it.

 

General Information

This series of items was designed to provide administrative information required for the records of the project under which the T-ASI was developed. Hospitals, clinics, or other institutions may need additional or different data to support their administrative records. Additions or changes to these items should be made as needed.

Controlled Environment refers to a living situation in which the subject was restricted in his or her freedom of movement and access. This usually means residential status in a treatment setting or detention center. If response to controlled environment is "no," enter "N" for number of days.

Severity Profile: The graph is provided as a summary of the patient's problem severity profile. Upon completion of the interview, the interviewer should mark the appropriate ratings on the grid. (Refer to the Interview Severity Rating on page 4).

 

CHEMICAL USE

Chemicals Used

Past Month (Item I): First ask the patient what drug(s) and/or alcohol he or she used in the past month. Use the drug list, located on the last page of the questionnaire, to prompt the patient. Allow the patient to view the list if he or she shows an interest to do so. Be sure to prompt the patient with examples (using slang and brand names) of drugs for each specific category . Do not tailor the substance use history section to the population being interviewed (e.g., an alcoholic may be combining drugs with drinking). Prescribed medication is counted under the appropriate generic category. Refer to the Appendix for list of common chemical agents listed by street name and T-ASI category.

Lifetime Use (Item 2) means we are trying to determine extended periods of use. Record the drug(s) and the age (years and months) yr/mo patient started and stopped use. Do not include any of the drugs and/or alcohol named in the previous item of past month use. Also, ask about frequency (rough estimate) of use.

Combination Chemicals (Item 3) is asking the patient how many days, over the past month, he or she took more than one type (T-ASI category) of chemical agent including alcohol.

Major Problem (Item 4): Record what the patient believes in his or her major chemical abuse problem. This list can be comprised of one or several drugs. If the patient uses one substance at a time, code it separately; if two substances are always or almost always used together, code them on the same line. Prioritize this list ranking the most problematic drug(s) first. If the patient maintains he or she has no drug or alcohol problem here, but later reports experiencing drug or alcohol problems on Item 18, then ask Item 4 again to determine what substance(s) he or she considers the major substance(s) of abuse.

Problem Area (Item 5): Ask the patient the reason he or she believes these drug(s) to be the major problem. Write the reason given; then categorize the statement according to the most appropriate problem area. The problem areas consist of the six other categories included in the T-ASI instrument. The patient does not participate in this categorization progress. The interviewer may code the problem area during or after the interview.

Abstinence (Item 6): Abstinence refers to all abused drugs including alcohol. Stress that this means his or her latest attempt, of at least one month duration of abstinence, not his or her longest abstinence. Record in the comments section if more than one substance is discussed. All time increments are measured in months, therefore, beyond the first each period of 2-4 weeks is counted as another month. Periods of hospitalization or incarceration are not counted. Periods of abstinence during which he or she was taking Methadone, Antabuse, or Naltrexone as an outpatient are included as a measure of the patient's ability to respond to outpatient treatment. If the abstinence period is current, enter 0." Enter "00" if the patient has never been abstinent.

Abstinence (Item 7): Calculate the number of months that can be derived from the previous question; report your calculation to the patient in order to double check the answer. All time increments are measured in months, therefore, beyond the first month each period of 2-4 weeks is counted as another month.

Blackout (Item 8) means that the patient experiences a loss of event memory following the last drink. Be sure the patient understands this definition of blackout.

Overdose (Item 8) refers to any incident in which intervention by someone was needed by the patient to recover. Ask the patient what was done to revive him or her. "Sleeping it off" does not constitute an OD. The nature of overdose will differ with the type of drug used. While opiates and barbiturates produce coma-like effects, amphetamine overdoses frequently result in toxic psychosis. Include suicide attempts if they were attempted by drug over dose.

Treatments (Item 9) refers to any type of alcohol or drug treatments, including detox, halfway houses, inpatient care, outpatient counseling, and AA or NA if 3 or more sessions are attended within a one month period. Exclude "Driving School" for DWI violations. Ask questions separately for alcohol and drugs. In the case of dual problems, try to learn the number of treatment in each category.

Detox Treatments (Item 10) should be recorded from number of treatments information learned in Item 9. These are detoxification only treatments and do not include any follow-up care. The purpose of this question is to determine the extent to which the patient has sought extended rehabilitation versus minimal stabilization.

Expense (Item 11) is primarily a measure of financial burden, not amount of use. Enter only amount of money spent, not the street drug value (e.g., dealer who uses but does not buy).

Sexual or Illegal (Item 12): This item inquires how drugs were obtained if patient did not use money to pay for them.

Outpatient Treatment (Item 13) refers to any type of outpatient substance abuse therapy including methadone maintenance, antabuse treatment, etc. Treatment requires personal (or at least telephone) contact with the treatment program. This does not include psychological counseling or other therapy for non-abuse problems.

Alcohol & Drug Problems (Item 18): Includes only craving, withdrawal symptoms, disturbing effects of drug or alcohol intoxication, or desire to stop but inability to do so. Stress that you are interested in the number of days the patient had problems directly related to his or her alcohol or drug use. Do not include the patient's inability to find drugs or alcohol.

Patient Ratings (Items 19 & 20): Refers to the time frame of the past month. Item 15 means specifically substance abuse treatment. not general therapy. Stress that you mean current substance abuse problem need not a rating of treatment need for these problems at a previous time when these needs may have been at their worst. Be sure the patient realizes this question pertains to all the preceding questions asked in this section. Review the previous answers to insure the patient is mindful of them before rating.

Interview Severity Rating (Item 2 1): Determine the patient's need for additional treatment.

 

SCHOOL STATUS

*Last month and the last three months relate to a consecutive period which means that if any interview is conducted during the first and second month of the academic year, the information should reflect the last three months of the previous academic year.

Missed (Items 2 & 3) refers to total days absent from school regardless of the reason for the absence.

Late (Items 4 & 5) refers to days in which school officials recorded or marked the patient as late or tardy.

Detention (Items 6 & 7) includes the total days the patient has had to do something for disciplinary reasons (i.e., spent time in detention, principal's or school counselor's office).

Suspended (Items 8 & 9) refers to both "in-house" and other temporary suspensions from school. Each suspension, whether for one or multiple days, should be recorded as one separate episode or suspension.

Grade Average (Items 12 & 13): Interviewer should ask patient and parent to approximate average of grades. If they are unable to do so, interviewer should try to elicit individual grades and approximate average from this information. Use school records if available. A= 1, B=2, C=3, D=4, F=5.

Extracurricular Activities & School Related Activities (Items 14 & 15) refers to officially sponsored or sanctioned school activities and not activities just participated in by school mates. Code each day activity as a separate day. If the patient is involved in three different activities after school, they are counted as three separate days.

Participation refers to active participation in the activity such as being a football player, band member, or a member of a school club (i.e., biology or forensics).

Attendance refers to taking a more passive role such as attending and watching the football game or the band practice.

Patient Rating (Items 16 & 17): Include only school related activities and/or problems directly related to school issues. If the patient is having problems with peers at school that involves only the social relationship, do not include. Be sure the patient realizes these questions pertain to all the preceding questions asked in this section. Review the previous answers to insure the patient is mindful of them.

 

 

 

 

EMPLOYMENT/SUPPORT STATUS

Only patients who are not school students will be interviewed using this domain. *Last month and last three months, please see note on school status.

Education Completed (Item I): Enter the years and months of education the patient has completed.

Left School (Item 2): Enter the time elapsed since leaving school. It may be necessary to ask the date of leaving school in order to elicit this information.

Training (Item 3): Enter the number of years and/or months patient has completed. Try to determine if this is valid training, such as a legitimate training program or an apprenticeship through a recognized on-the-job-training program.

Skill (Item 4): If the patient answers "yes," note the trade. In general, a trade will be counted as any employable, transferable skill that was acquired through specialized training or education.

Employment Pattern (Items 5 & 6): Full-time work (include under-the-table jobs, however, define them in the comments section) is regular and greater than 3 5 hours per week; also include full-time students. Regular part-time work is a job in which the patient has a regular, continued schedule less than 35 hours per week., also include part-time students. Irregular part-time work refers to jobs in which the patient works irregularly; i. c., work programs, day work, etc. When there are equal times for more than one category, record that which best represents the situation for that particular time period.

Longest Period of Employment (Item 7) refers to the longest consecutive period of days employed.

Days Paid (Items 8 & 9): Record number of days the patient was paid for working. Jobs held during incarceration, placement, or hospitalization are not counted. 'Under-the-table" jobs are included. Paid sick days and vacation days are included.

Days Late (Items 10 & 11): Record the number of days the patient was late for scheduled working hours.

Days Missed (Items 12 & 13): Record the number of days missed for any reason, i.e., sick, personal reasons, skipped, etc.

Days Sick (Items 14 & 15): Record the number of days missed due only to being W.

Times Fired (Items 16 & 17): Fired means the patient was asked to leave the job involuntarily by his or her employer.

Times Laid 0 (Items 18 & 19): Laid off refers to times the patient was dismissed due to employer being unable to pay the patient for his or her services.

Job Performance Satisfaction (Items 20 & 2l): Be sure the patient realizes that this question pertains to all the previous questions asked in this section. This is a general and global measure that can also include positive or negative factors not included in the questions, but that sway the patient's answer. Be sure to include these factors in the comments section.

Looking for a Job (Items 22 & 23) means actively filling out applications and interviewing or answering an add by phone.

Employment Problems. Past Month (Item 24): Include inability to find work (only if patient has actively tried), problems with his or her present employment (if his or her employment is in jeopardy), etc. Do not include problems in "finding a job" which are directly related to the patient's substance abuse such as withdrawal or hangover. Do not include feelings about his or her employment prospects in the absence of any attempts to find work.

Contribution to Support (Item 26): Ascertain whether or not the patient is receiving any regular support from family (include spouses support), caretaker, friend(s) institution or government agency. Note source and amount in comment section.

Majority of Support (Item 27): If item 26 is "yes," learn if source provides majority of support.

Illegal Income (Item 28) includes money obtained illegally from drug dealing, stealing, "fencing" stolen goods, illicit gambling, etc. Work out a dollar amount with the patient and obtain a percentage considering all income.

Support (Item 29): Stress that these people must depend upon the patient for financial support, not simply people to whom the patient has given money. Do not include the patient. Include dependents who are normally supported by the patient but due to unusual circumstances, have not received support recently. Alimony and child support payments are included.

Patient Ratings (Items 30 & 3 1): These items take into consideration all of the preceding questions. Be sure to remind the patient to keep in mind these answers (i.e., training, days paid, late days, and times fired) before choosing a rating. Review these previous answers to insure the patient is mindful of them. For item 3 1, stress that you mean help finding or preparing for a job, not giving the patient a job.

 

FAMILY RELATIONS

Current Living Arrangements (Item I): Consider the patient's life in the past year and ask him or her to describe the amount of time spent living at home, in hospitals or other institutions. If the patient lived in several arrangements, choose the most representative. Record information in the comments section.

Length of Time in Current Arrangements (Item 2): Enter number of years and months patient has lived in his or her current living situation.

Satisfied (Item 3): A "satisfied" response must indicate that the patient generally likes the situation, not that he or she is merely resigned to it.

Conflicts/Problems (Items 4 & 5): Conflicts require personal or at least telephone contact. Stress that you mean serious conflicts (e.g., serious arguments, verbal abuse, etc.), not simply routine differences of opinion. These conflicts should be of such a magnitude that they jeopardized the patient's relationship with the person involved. These problems include extremely poor communication, complete lack of trust or understanding, animosity, chronic arguments. If the patient has not been in contact with that person in the time frame asked, record 'N," unless he or she is extremely bothered by a relatively recent problem, in which case a "yes" should be recorded. W should be recorded when there is no family member in a given category (i.e., patient with no siblings).

Items 6 - 11: These items refer to biological family if meetings (not phone contact) take place at least once a week. Otherwise, this refers to current caretaker(s).

Physical/Sexual Abuse (Items 12 - 15): These items refer to any physical/sexual contact by biological family or caretaker(s). If the patient endorses "yes" to any of these items, this information must immediately be passed on to the clinicians responsible for reporting any instances of abuse to Children and Youth Services (CYS).

Patient Rating (Items 16 & 17): These refer to any dissatisfaction, conflicts, or problems reported in the Family section. For item 23, be sure that the patient is aware that he or she is not rating whether or not his or her family would agree to participate, but how badly he or she needs counseling for family problems in whatever form.

 

 

 

 

PEER/SOCIAL RELATIONSHIPS

Close Friends (Item I): Stress you mean close. These are friends with whom the patient regularly communicates, confides, and/or participates in activities. Do not include family members or a girlfriend who is considered to be a family member.

Close Friends and Drugs (Item 2): First learn how many of these close friends "regularly" use drugs. Regular use is defined as a period of use not less than one month. The frequency of use that constitutes "regular" is generally considered one or more times per week.

Conflicts/Arguments (Items 3, 4, & 10, 11): Conflicts require personal or at least telephone contact. Stress that you mean serious conflicts (e.g., serious arguments, verbal abuse, etc.), not simply routine differences of opinion. These conflicts should be of such a magnitude that they jeopardized the patient's relationship with the person involved. These problems include extremely poor communication, complete lack of trust or understanding, animosity, chronic arguments. If the patient has not been in contact with that person in the time frame asked, record "N"; unless he or she is extremely bothered by a relatively recent problem, in which case a "yes" should be recorded.

Satisfaction with Quality of Relationship (Item 5): Be sure the patient realizes that this question pertains to all the previous questions asked in this section. This is a general and global measure that can also include positive or negative factors not included in the questions but that sway the patient's rating. Be sure to include these factors in the comments section. Boy/girlfriend(s) are not included here; they are included in Item 21.

 

Length of Boy/Girlfriend Relationship (Item 7): Score any number of days below or equal to 30 as one month. Each consecutive period longer than one week onto the next month is counted as another month. Measurements are calculated in monthly increments.

Drug(s) Use of Current Boy/Girlfriend (Item 9): Refer to item 2. Code only current boy/girlfriend. If patient has more than one, code the drug usage of the most deviant. Code A drugs the patient identifies. In the comments section, write all slang terms and ask the patient to identify the substance. If the patient cannot do this, ask them to identify the effects if he or she also used the drug, or to describe the behavior and condition of the boy/girlfriend.

Satisfaction with Quality Of Relationship (Item 12): Be sure the patient realizes that this question pertains to all the previous questions asked about boy/girlfriend relationship(s) in this section. This is a general and global measure that can also include positive or negative factors not included in the questions but that sway the patient's rating. Be sure to include these factors in the comments section. Only boy/girlfriend relationship(s) are included here.

Patient Ratings (Items 14 & 15): Remind the patient to consider previous answers that pertain to free time and friend(s) questions. Review previous answers to insure patient is mindful of them before rating. This is a global measure that can include positive or negative factors not covered in the questions but that sway the patient's answer. Be sure to include any additional information in the comments section.

Interviewer Severity Rating (Items 16): These refer to any dissatisfaction, conflicts, or problems discussed regarding social relationships and free time. Consider presented social problems such as loneliness, inability to socialize, and dissatisfaction with friends.

 

LEGAL STATUS

Admission Source (Item I): Enter "yes if any member of the criminal justice system is responsible for the patient's current admission or if the patient will suffer undesirable legal consequences as a result of refusing or not completing treatment.

Probation/Parole (Item 2): It may be helpful to note duration and level of probationary status separately. At age 18 an adolescent is considered an adult, therefore, probation is then called parole.

Changes (Item 3): This is a record of the number and type of arrest counts and charges (not necessarily convictions) accumulated by the patient during his or her life. Be sure to count the total number of counts (if known), not just arrests. These include times when the patient was picked up or questioned (record any additional information in the comments section). Include under "Other" serious charges such as "terroristic threats," contempt of court, etc. Note in the comments section if the court tried the patient as an adult, as is the case in particularly serious offenses.

Although not formally part of the interview, interviewer should ask how many times each of the above crimes has been committed without questioning, charges, or conviction. Record these in the comments section. Please refer to the following list of offenses

Shoplifting - The stealing of goods from a store or shop.

Vandalism - Willful or malicious injury to, or the destruction of, property.

Parole/Probation Violation - Breach of agreed upon rules of acceptable conduct.

Drug Charges - Any illegal possession of a chemical substance that has resulted in charges filed.

Forge - False making or material alteration, with intent to defraud or injure.

Weapons Offense - Unlawful possession or use of a weapon.

Burglary or Breaking & Entering - The act of breaking and entering into the dwelling or structure of another, with intent to commit a felony (high crimes; murder, treason, robbery, larceny, etc.) therein.

Robbery - Taking from the person of another, against his or her will, property belonging to or in the care of him or her.

Assault - Demonstration of unlawful intent by one person to inflict immediate injury on the person of another then present. An intentional attempt by force or violence to injure another person.

Arson - Malicious voluntary or willful burning of another's dwelling or structure.

Rape - Sex forced and without consent.

Homicide - Any mode one person's life is taken by another. Homicide includes unlawful killing, murder, and manslaughter.

Manslaughter -

a) Unlawful killing of another, without malice, through the violence of sudden passion brought on by some great provocation.

b) When death is caused by some unlawful act, not accompanied with any intention to take life.

First Degree - Involuntary; killing by negligence.

Second Degree - Killing of one human by another without design to effect death.

Third Degree - Killing of one human by another in the heat of passion, without design to effect death.

Prostitution - The act or practice of indulging in promiscuous sexual relations, especially for money, drugs, or some other reward.

Disorderly Conduct - An act which tends to breach the peach or disturb those people who hear or see it, or to endanger the morals, safety, or health of the community or a class of persons or a family.

Vagrancy - The wandering from place by an idle person without lawful visible means of support, subsisting on charity, refraining from working for a living although able to work.

Public Intoxication - Creating a public disturbance while in an intoxicated state.

Driving While Intoxicated (DWI) - Driving a vehicle while being at or over what state law considers illegal blood alcohol level.

Major Driving Violations - Reckless driving, speeding, no license, etc.

Public Annoyance - Creating a public disturbance.

Truancy - One who stays out of school without permission.

Convictions (Item 4): Note that convictions include fines, probation, suspended sentences as well as sentences requiring incarceration. Convictions also include guilty pleas. Parole violations are automatically counted as convictions.

Incarcerations (Item 5): Enter the total number of months spent in jail, youth detention center, or court-ordered placement (regardless of whether the charge resulted in a conviction). If the patient was detained as an adult, while still a juvenile, record this in the comments section.

Incarceration Length (Item 6): Enter "N" if the patient has never been incarcerated.

Charge (Item 7): If the patient was incarcerated for several charges, enter the most serious or the one for which he or she received the most severe sentence. Enter "N" if the patient has never been incarcerated.

Charges (Item 9): Enter "N" if the patient is not awaiting charges, trial, or sentence. Do not include civil lawsuits unless a criminal offense (contempt of court) is involved.

Incarceration (Item 10): Include being detained; e.g., arrested but released on the same day.

Illegal Activities (Item 11): Enter the number of days the patient engaged in crime for profit. Do not count simple drug possession. However, do not include drug dealing, prostitution, burglary, selling stolen goods, etc.

Patient Ratings (Items 12 & 13): These items take into consideration all of the preceding questions. Be sure to remind the patient to keep in mind these answers. Review the previous answers to insure the patient is mindful of them. Do not include any civil problems. For item 13, the patient is rating his or her need for referral to legal counsel.

 

PSYCHIATRIC STATUS

Treatments (Item 1): This includes any type of treatment for psychiatric problems. This does not include substance abuse, employment, or family counseling. The unit of measure is a treatment episode, not the number of visits or days in treatment.

Psychiatric Symptoms (Items 2-9): These items are concerned with serious psychiatric symptoms. Items 2, 3, & 5 concerning depression, anxiety, and concentration are addressing serious periods of disturbance, not simply a day. The other symptoms (items 4, 5, 7, 8, & 9) are of sufficient importance that even brief existence warrants they be recorded.

Depression (Item 2): Suggested by sadness, hopelessness, significant loss of interest, listlessness, difficulty with daily function, guilt, "crying jags," etc.

Anxiety (Item 3): Suggested by tension, feeling uptight, unable to feel relaxed,

unreasonable fearful, etc.

Delusions (Item 4): Delusions are convictions or fixed beliefs which almost certainly are not true and which are not shared with members of the subject's religious or cultural subgroup. They may be fleeting in that the subject has a conviction in the truth of the belief for a brief time only, or they may be sustained.

Hallucinations (Item 5): Times when the patient saw things or heard voices not present. This is restricted to times when the patient was drug-free and not undergoing withdrawal.

Cognitive Problems (Item 6): Suggested by serious trouble in concentrating, remembering and/or understanding.

Difficulty Controlling (Item 7) or losing control, rage or violence.

Suicide Thoughts (Item 8): Restricted to times when the patient seriously considered a plan or method for taking his or her life.

Suicide Attempts (Item 9): Suicidal gestures or attempts. Important: Ask the patient if he or she has recently considered suicide. If the patient answers "yes" to this question, and/or gives the distinct impression of being depressed to the point where suicide may become a possibility, notify a member of the treatment staff immediately of this situation.

Medication (Item 10): Medication must have been prescribed by a physician for a psychiatric or emotional problem.

Days Experiencing Problems (Item 11): Restrict the question to those problems list items 2-9.

Patient Ratings (Items 12 & 13): These items take into account all of the preceding questions. Review previous answers to insure the patient is mindful of them before choosing a rating. Referring to item 11, have the patient rate the extent of those problems in the past month. Be sure the patient understands that you do not mean transfer to a psychiatric ward or starting, adding, or increasing psychotropic medication(s).

Present Symptoms (Items 14-19): The interviewer should use his or her judgment based upon the patient's behavior and the answers during the interview, to determine presence of overt symptoms in these categories.

 

 

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