COSIG Assessment Training

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COSIG AssessmentTraining
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M.I.N.I

• MINI INTERNATIONAL NEUROPSYCHITRIC INTERVIEW

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Major Depressive EpisodeScreening Questions

• A1 Have you been consistently depressed or down,
• most of the day, nearly every day, for the
  past two
• weeks?
• A2 In the past two weeks, have you been much
  less
• interested in most things or much less
  able to
• enjoy the things you used to enjoy most of
  the
• time?
• If YES to either question, proceed to A3
• If NO to both questions, skip to Section B,
  Dysthmia

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Major Depressive Episode (Continued)

• A3 Over the past two weeks, when you felt
• depressed or uninterested
• Was your appetite decreased or increased nearly
  every day? Did your weight increase without
  trying intentionally?
• Did you have trouble sleeping nearly every night
  (difficulty falling asleep, waking up in the
  middle of the night, early morning wakening, or
  sleeping excessively)?

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Major Depressive Episode (Continued)

• Did you talk or move more slowly than normal or
  were you fidgety, restless, or having trouble
  sitting still almost every day?
• Did you feel tired or without energy almost every
  day?
• Did you feel worthless or guilty almost every
  day?
• Did you have difficulty concentrating or making
  decisions almost every day?
• Did you repeatedly consider hurting yourself,
  feel suicidal, or wish that you were dead?

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Major Depressive Episode (Continued)

• If 5 or more of the 7 symptoms are YES in A3
  then the diagnosis of Major Depressive Episode,
  Current is made and proceed to A4
• If less than 5 of the 7 symptoms are YES in A3
  then skip to Section B, Dysthmia

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Major Depressive Episode, Recurrent

• A4 During your lifetime, did you have other
  periods of two
• weeks or more when you felt depressed or
  uninterested in
• most things, and had most of the problems
  we just talked
• about?
• If YES, proceed to next question
• If NO, proceed to Section D, Manic Episode
• Did you ever have an interval of at least 2
  months without
• any depression and any loss of interest
  between 2 episodes of
• depression?
• If YES, Major Depressive Episode, Recurrent
• diagnosis is made

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DysthmiaScreening Question

• B1 Have you felt sad, low, or depressed most of
• the time for the last two years?
• If YES proceed to B2
• If NO skip to Section D, Manic Episode

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Dysthmia (Continued)

• B2 Was this period interrupted by your feeling
• OK for two months or more?
• If YES skip to Section D, Manic Episode
• If NO proceed to B3

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Dysthmia (Continued)

• B3 During this period of feeling depressed most
• of the time
• Did your appetite change significantly?
• Did you have trouble sleeping or sleep
  excessively?
• Did you feel tired or without energy?
• Did you lose self-confidence?
• Did you have trouble concentrating or making
  decisions?
• Did you feel hopeless?

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Dysthmia (Continued)

• If two or more symptoms in B3 are YES proceed
  to B4
• If less than 2 symptoms are YES in B3 skip to
  Section D, Manic Episode

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Dysthmia (Continued)

• B4 Did the symptoms of depression cause you
• significant distress or impair your ability
  to
• function at work, socially or in some other
• important way?
• If YES Dysthmia diagnosis is made
• If NO proceed to Section D, Manic Episode

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Manic and Hypomanic EpisodeScreening Questions

• D1a Have you ever had a period when you were
• feeling up or high or hyper or so
  full of
• energy or full of yourself that you got
  into
• trouble, or that other people thought you
  were
• not your usual self? (Do not consider
  times
• when you were intoxicated on drugs or
  alcohol.)
• If YES ask
• D1b Are you currently feeling up or high or
  full
• of energy?

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Manic and Hypomanic EpisodeScreening Questions

• D2a Have you ever been persistently irritable,
  for
• several days, so that you had arguments
  or
• verbal or physical fights, or shouted at
  people
• outside your family? Have you or others
• noticed that you have been more
  irritable or
• over reacted, compared to other people,
  even in
• situations that you felt were justified?
• If Yes ask
• D2b Are you currently feeling persistently
  irritable?

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Manic or Hypomanic Episode(Continued)

• If D1b or D2b is YES proceed to D3 and explore
  only current episode
• If D1b and D2b are NO proceed to D3 and explore
  the most problematic past episode
• If D1a and D2a are both NO skip to Section E,
  Panic Disorder

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Manic and Hypomanic Episode(Continued)

• D3 During the times when you felt high, full of
• energy, or irritable did you
• Feel that you could do things others couldnt do,
  or that you were an especially important person?
• Need less sleep (for example, feel rested after
  only a few hours sleep)?
• Talk too much without stopping, or so fast that
  people had difficulty understanding?
• Have racing thoughts?

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Manic and Hypomanic Episode(Continued)

• D3 During the times when you felt high, full of
• energy, or irritable did you (continued)
• Become easily distracted so that any little
  interruption could distract you?
• Become so active or physically restless that
  others were worried about you?
• Want so much to engage in pleasurable activities
  that you ignored the risks or consequences (for
  example, spending sprees, reckless driving, or
  sexual indiscretions)?

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Manic and Hypomanic Episode(Continued)

• If 3 or more of the D3 symptoms are YES (or 4
  or more symptoms if D1a is NO when rating past
  episode or D1b is NO when rating current
  episode) then proceed to D4
• If less than 3 symptoms are present, skip to
  Section E, Panic Disorder

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Manic or Hypomanic Episode(Continued)

• D4 Did these symptoms last at least a week and
• cause significant problems at home, at
  work,
• socially, or at school, or were you
  hospitalized
• for these problems?
• If D4 is NO the diagnosis of Hypomanic Episode
  (Current or Past) is made
• If D4 is YES the diagnosis of Manic Episode
  (Current or Past) is made

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Panic DisorderScreening Questions

• E1a Have you, on more than one occasion, had
• spells or attacks when you suddenly felt
  
• anxious, frightened, uncomfortable or
  uneasy, even
• in situations where most people would not
  feel that
• way?
• E1b Did the spells surge to a peak within 10
  minutes of
• starting?
• If E1a and E1b are YES then proceed to E2

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Panic Disorder(Continued)

• E2 At any time in the past, did any of those
  spells
• or attacks come on unexpectedly or occur in
• an unpredictable manner?
• If E2 is YES proceed to E3
• If E2 is NO skip to Section H, Obsessive
  Compulsive Disorder

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Panic Disorder(Continued)

• E3 Have you ever had one such attack followed
• by a month or more of persistent concern
• about having another attack, or worries
  about
• the consequences of the attack?

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Panic Disorder(Continued)

• E4 During the worst spell that you can remember
• Did you have skipping, racing, or pounding of
  your heart?
• Did you have sweating or clammy hands?
• Were you trembling or shaking?
• Did you have shortness of breath or difficulty
  breathing?
• Did you have a choking sensation or lump in your
  throat?

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Panic Disorder(Continued)

• E4 During the worst spell that you can remember
• Did you have chest pain, pressure, or discomfort?
• Did you have nausea, stomach problems, or sudden
  diarrhea?
• Did you feel dizzy, unsteady, lightheaded, or
  faint?
• Did things around you feel strange, unreal,
  detached or unfamiliar, or did you feel outside
  of or detached from part or all of your body?

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Panic Disorder(Continued)

• E4 During the worst spell that you can remember
• Did you fear that you were losing control or
  going crazy?
• Did you fear that you were dying?
• Did you have tingling or numbness in parts of
  your body?
• Did you have hot flushes or chills?

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Panic Disorder(Continued)

• If E3 is YES and 4 or more of the symptoms in
  E4 are YES, diagnosis of Panic Disorder,
  Lifetime is made and proceed to E7
• E7 In the past month, did you have such attacks
• repeatedly (2 or more) followed by
  persistent
• concern about having another attack?
• If E7 is YES, diagnosis of
• Panic Disorder, Current is made

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Obsessive-Compulsive DisorderScreening Question

• H1 In the past month, have you been bothered by
• recurrent thoughts, impulses, or images
  that
• were unwanted, distasteful, inappropriate,
• intrusive, or distressing?
• If H1 is YES proceed to H2
• IF H1 is NO skip to H4

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Obsessive-Compulsive Disorder(Continued)

• H2 Did they keep coming back into your mind
• even when you tried to ignore or get rid
  of
• them?
• IF H2 is YES proceed to H3
• If H2 is NO skip to H4

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Obsessive-Compulsive Disorder(Continued)

• H3 Do you think that these obsessions are the
• product of your own mind and that they are
• not imposed from the outside?
• If YES then criteria for Obsessions has
• been met and proceed to H4

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Obsessive-Compulsive Disorder(Continued)

• H4 In the past month, did you do something
  repeatedly
• without being able to resist doing it,
  like washing or
• cleaning excessively, counting or checking
  things
• over and over, or repeating, collecting,
  arranging
• things, or other superstitious rituals?
• If YES then criteria for Compulsions has been
  met
• and proceed to H5
• If both H3 and H4 are NO skip to Section J,
  Alcohol Abuse and Dependence

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Obsessive-Compulsive Disorder(Continued)

• H5 Did you recognize that either these obsessive
• thoughts or these compulsive behaviors
  were
• excessive or unreasonable?
• If H5 is YES proceed to H6
• If H5 is NO skip to Section J, Alcohol
• Abuse and Dependence

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Obsessive-Compulsive Disorder(Continued)

• H6 Did these obsessive thoughts and/or
• compulsive behaviors significantly
  interfere
• with your normal routine, occupational
• functioning, usual social activities, or
• relationships, or did they take more than
  one
• hour a day?
• If YES then diagnosis of Obsessive-Compulsive
  Disorder is made

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Posttraumatic Stress DisorderScreening Questions

• I1 Have you ever experienced or witnessed or had
• to deal with an extremely traumatic event
  that
• included actual or threatened death or
  serious
• injury to you or someone else?
• If YES proceed to I2
• If NO skip to Section J, Alcohol Abuse
• and Dependence

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Posttraumatic Stress DisorderScreening Questions

• I2 Did you respond with intense fear,
• helplessness, or horror?
• If YES proceed to I3
• If NO skip to section J, Alcohol Abuse
• and Dependence

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Posttraumatic Stress Disorder

• I3 During the past month, have you re-
• experienced the event in a distressing way
  (such
• as dreams, intense recollections,
  flashbacks, or
• physical reactions)?
• If YES proceed to I4
• If NO skip to Section J, Alcohol Abuse
• and Dependence

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Posttraumatic Stress Disorder(Continued)

• I4 In the past month
• Have you avoided thinking about or talking about
  the event?
• Have you avoided activities, places, or people
  that remind you of the event?
• Have you had trouble recalling some important
  part of what happened?
• Have you become much less interested in hobbies
  and social activities?

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Posttraumatic Stress Disorder(Continued)

• I4 In the past month
• Have you felt detached or estranged from others?
• Have you noticed that your feelings are numbed?
• Have you felt that your life will be shortened or
  that you will die sooner than other people?
• If 3 or more of the 7 symptoms in I4 are
• YES proceed to I5
• If less than 3 symptoms are YES skip to Section
  J, Alcohol Abuse and Dependence

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Posttraumatic Stress Disorder(Continued)

• I5 In the past month
• Have you had difficulty sleeping?
• Were you especially irritable or did you have
  outbursts of anger?
• Have difficulty concentrating?
• Were you nervous or constantly on your guard?
• Were you easily startled?
• If 2 or more symptoms in I5 are YES proceed to
  I6
• If less than 2 symptoms are YES skip to Section
  J

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Posttraumatic Stress Disorder(Continued)

• I6 During the past month, have these problems
• significantly interfered with your work or
  social
• activities, or caused significant distress?
• If YES diagnosis of Posttraumatic Stress
  Disorder is made
• If NO proceed to Section J, Alcohol Abuse
• and Dependence

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Alcohol Abuse and DependenceScreening Question

• J1 In the past 12 months, have you had 3 or more
• alcoholic drinks within a 3 hour period on 3
  or
• more occasions?
• If YES proceed to J2
• If NO skip to Section K, Psychoactive Substance
  Use Disorders

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Alcohol Abuse and Dependence(Continued)

• J2 In the past 12 months
• Did you need to drink more in order to get the
  same effect that you got when you first started
  drinking?
• When you cut down on drinking, did your hands
  shake, did you sweat or feel agitated? Did you
  drink to avoid these symptoms or to avoid being
  hung over, for example the shakes, sweating, or
  agitation? (If YES to either, code YES)

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Alcohol Abuse and Dependence(Continued)

• J2 In the past 12 months
• During the times when you drank alcohol, did you
  end up drinking more than you planned when you
  started?
• Have you tried to reduce or stop drinking alcohol
  but failed?
• On the days that you drank, did you spend
  substantial time in obtaining alcohol, drinking,
  or recovering from the effects of alcohol?

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Alcohol Abuse and Dependence(Continued)

• J2 In the past 12 months
• Did you spend less time working, enjoying
  hobbies, or being with others because of your
  drinking?
• Have you continued to drink even though you knew
  that the drinking caused you health or emotional
  problems?

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Alcohol Abuse and Dependence(Continued)

• If 3 or more questions in J2 are YES then
  diagnosis of Alcohol Dependence is made and skip
  to Section K, Psychoactive Substance
• Use Disorders
• If less than 3 questions in J2 are YES then
  proceed to J3 to assess for Alcohol Abuse

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Alcohol Abuse and Dependence(Continued)

• J3 In the past 12 months
• Have you been intoxicated, high, or hung over
  more than once when you had other
  responsibilities at school, work, or at home?
  Did this cause any problems? (Code YES only if
  this caused problems.)
• Were you intoxicated more than once in any
  situation where you were physically at risk, for
  example, driving a car, riding a motorbike, using
  machinery, etc.?

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Alcohol Abuse and Dependence(Continued)

• J3 In the past 12 months
• Did you have legal problems more than once
  because of your drinking, for example, an arrest
  or disorderly conduct?
• Did you continue to drink even though your
  drinking caused problems with your family or
  other people?

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Alcohol Abuse and Dependence(Continued)

• If one or more questions in J3 are YES then
  diagnosis of Alcohol Abuse is made
• If no questions in J3 are YES proceed to
  Section K, Psychoactive Substance Use Disorders

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Psychoactive Substance Use DisordersScreening
Question

• K1 Now I am going to show (or read) you a list
• of street drugs or medications. In the
  past 12
• months, did you take any of these drugs
  more
• than once, to get high, to feel better, or
  to
• change your mood?
• If YES proceed to K2
• If NO skip to Section L, Psychotic Disorders

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Psychoactive Substance Use Disorders(Continued)

• K2 Considering your use of (specified drug), in
  the past
• 12 months
• Have you found that you needed to use more
  (specified drug) to get the same effect that you
  did when you first started taking it?
• When you reduced or stopped using (specified
  drug), did you have withdrawal symptoms (aches,
  shaking, fever, weakness, diarrhea, nausea,
  sweating, heart pounding, difficulty sleeping, or
  feeling agitated, anxious, irritable, or
  depressed)? Did you use any drug(s) to keep
  yourself from getting sick (withdrawal symptoms)
  or so that you would feel better? (If YES to
  either, code YES)

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Psychoactive Substance Use Disorders(Continued)

• K2 Considering your use of (specified drug), in
  the past
• 12 months
• Have you often found that when you used
  (specified drug), you ended up taking more than
  you thought you would?
• Have you tried to reduce or stop taking
  (specified drug) but failed?
• On the days that you used (specified drug), did
  you spend substantial time (gt 2 hours),
  obtaining, using, or in recovering from the drug,
  or thinking about the drug?

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Psychoactive Substance Use Disorders(Continued)

• K2 Considering your use of (specified drug), in
• the past 12 months
• Did you spend less time working, enjoying
  hobbies, or being with family or friends because
  of your drug use?
• Have you continued to use (specified drug) even
  though it caused you health or mental problems?

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Psychoactive Substance Use Disorders(Continued)

• If 3 or more of the questions in K2 are
• YES then diagnosis of Substance
• Dependence is made
• If less than 3 questions in K2 are YES proceed
  to K3 to assess Substance Abuse

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Psychoactive Substance Use Disorder(Continued)

• K3 Considering your use of (specified drug), in
  the past
• 12 months
• Have you been intoxicated, high, or hung over
  from (specified drug) more than once, when you
  had other responsibilities at school, at work, or
  at home? Did this cause any problems? (Code
  YES only if this caused problems)
• Have you been high or intoxicated from (specified
  drug) more than once in any situation where you
  were physically at risk (for exammple, driving a
  car, riding a motorbike, using machinery,
  boating, etc.)?

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Psychoactive Substance Use Disorder(Continued)

• K3 Considering your use of (specified drug), in
  the past
• 12 months
• Did you have legal problems more than once
  because of your drug use, for example, an arrest
  or disorderly conduct?
• Did you continue to use (specified drug) even
  though it cause problems with your family or
  other people?
• If one or more of the questions in K3 are YES
• then diagnosis of Substance Abuse is made

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Psychotic Disorders

• There are no screening questions for the
  Psychotic Disorders section
• Ask for an example of each question answered
  positively. Code YES only if the examples
  clearly show a distortion of thought or of
  perception or if they are not culturally
  appropriate.

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Psychotic Disorders(Continued)

• Before coding, investigate whether delusions
  qualify as bizarre.
• Delusions are bizarre if clearly implausible,
  absurd, not understandable, and cannot derive
  from ordinary life experience.
• Hallucinations are coded bizarre if a voice
  comments on the persons thoughts or behavior, or
  when two or more voices are conversing with each
  other.

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Psychotic Disorders(Continued)

• Now I am going to ask you about unusual
  experiences that some people have
• L1 Have you ever believed that people were
• spying on you, or that someone was plotting
• against you, or trying to hurt you? (Note
  Ask
• for examples to rule out actual stalking.)
• If YES Do you currently believe these things?

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Psychotic Disorders(Continued)

• L2 Have you ever believed that someone was
• reading your mind or could hear your
• thoughts, or that you could actually read
• someones mind or hear what another person
• was thinking?
• If YES Do you currently believe these things?

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Psychotic Disorders(Continued)

• L3 Have you ever believed that someone or some
• force outside yourself put thoughts in your
• mind that were not your own, or made you
  act
• in a way that was not your usual self?
  Have
• you ever felt that you were possessed?
• If YES Do you currently believe these things?

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Psychotic Disorders(Continued)

• L4 Have you ever believed that you were being
• sent special messages through the TV,
  radio,
• or newspaper, or that a person you did not
• personally know was particularly interested
  in
• you?
• If YES Do you currently believe these things?

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Psychotic Disorders(Continued)

• L5 Have your relatives or friends ever
  considered any of
• your beliefs strange or unusual?
• Note Ask for examples and only code YES if
  the
• examples are clearly delusional ideas that
  were not
• explored in questions L1-L4. For example,
  somatic or
• religious delusions or delusions of
  grandiosity,
• jealousy, guilt, ruin, destitution, etc.
• If YES Do they currently consider your
  beliefs as
• strange?

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Psychotic Disorders(Continued)

• L6 Have you ever heard things other people
  couldnt
• hear, such as voices?
• Note Hallucinations are scored bizarre only
  if patient
• answers YES to the following
• If YES Did you hear a voice commenting on your
• thoughts or behavior or did you hear two or
  more
• voices talking to each other?
• If YES Have you heard these things in the past
  month?

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Psychotic Disorders(Continued)

• L7 Have you ever had visions when you were
• awake or have you ever seen things other
• people couldnt see?
• Note Check to see if these are culturally
• appropriate.
• If YES Have you seen these things in the past
• month?

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Psychotic Disorders(Continued)

• Clinicians Judgment Items
• L8 Is the patient currently exhibiting
  incoherence,
• disorganized speech, or marked loosening of
• associations?
• L9 Is the patient currently exhibiting
  disorganized
• or catatonic behavior?

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Psychotic Disorders(Continued)

• Clinicians Judgment Items
• L10 Are negative symptoms of schizophrenia,
• such as affective flattening, poverty of
  speech
• (alogia) or an inability to initiate or
  persist in
• goal-directed activities (avolition),
  prominent
• during the interview?

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Psychotic Disorders(Continued)

• If one or more of the questions from L1a to L7b
• are YES or YES Bizarre and also met
  criteria for Major Depressive Episode (Current or
  Recurrent) or Manic or Hypomanic Episode (Current
  or Past) then proceed to L11b

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Psychotic Disorders(Continued)

• L11b You told me earlier that you had periods
• when you felt (depressed/high/persistent
  ly
• irritable).
• Were the beliefs and experiences you just
• described (symptoms coded YES from
• L1a to L7a) restricted exclusively to
  times
• when you were feeling depressed/high/
• irritable?

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Psychotic Disorders(Continued0

• If the patient ever had a period of at least 2
  weeks of having these beliefs or experiences
  (psychotic symptoms) when they were not
  depressed, high or irritable, code NO on both
  Mood Disorder with Psychotic Features, Lifetime
  and Current and proceed to L13
• If L11b is YES then diagnosis of Mood Disorder
  with Psychotic Features, Lifetime is made and
  proceed to L12

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Psychotic Disorders(Continued)

• If one or more of the questions from L1b to L7b
• are YES or YES Bizarre and also met
  criteria for Major Depressive Episode, Current or
  Manic or Hypomanic Episode, Current then
  diagnosis of Mood Disorder with Psychotic
  Features, Current is made

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Psychotic Disorders(Continued)

• L13 Are one or more of the L1b L7b questions
  coded YES Bizarre?
• OR
• Are 2 or more of the L1b-L7b questions coded
  YES (rather than YES Bizarre)?
• If YES then diagnosis of Psychotic
• Disorder, Current is made

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Psychotic Disorders(Continued)

• L14 Is L13 coded YES for Psychotic Disorder,
• Current diagnosis
• OR
• Are one or more questions from L1a L7a coded
• YES Bizarre
• OR
• Are 2 or more questions from L1a L7a coded
  YES
• (rather than YES Bizarre)
• AND
• Did at least two of the psychotic symptoms occur
  during
• the same time period?

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Psychotic Disorders(Continued)

• If any of the conditions in L14 are met,
• the diagnosis of Psychotic Disorder, Lifetime
• is made and proceed to Section O, Generalized
  Anxiety Disorder

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Generalized Anxiety DisorderScreening Questions

• O1 Have you worried excessively or been anxious
• about several things over the past 6
  months?
• Are these worries present most days?
• If YES to both of these questions AND the
  patients anxiety is not restricted exclusively
  to, or better explained by any disorder prior to
• this point, proceed to O2

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Generalized Anxiety Disorder(Continued)

• O2 Do you find it difficult to control the
  worries
• or do they interfere with your ability to
  focus
• on what you are doing?
• If YES proceed to O3
• If NO interview is complete

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Generalized Anxiety Disorder(Continued)

• O3 For the following items, code NO if the
• symptoms are confined to features of any
• disorders explored prior to this point.
• When you were anxious over the past 6 months
• did you, most of the time
• Feel restless, keyed up, or on edge?
• Feel tense?
• Feel tired, weak, or exhausted easily?

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Generalized Anxiety Disorder(Continued)

• O3 When you were anxious over the past 6
• months, did you, most of the time
• Have difficulty concentrating or find your mind
  going blank?
• Feel irritable?
• Have difficulty sleeping (difficulty falling
  asleep, waking up in the middle of the night,
  early morning wakening or sleeping excessively)?

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Generalized Anxiety Disorder(Continued)

• If 3 or more of the symptoms in O3 are
• coded YES then diagnosis of
• Generalized Anxiety Disorder is made
• If less than 3 symptoms are YES interview
• is complete

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Brief Symptom Inventory

• (BSI)

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Brief Symptom Inventory

• The BSI is a client self-report that measures
  psychological symptom severity on nine primary
  dimensions and three global severity indices.
• The inventory contains 53 items and takes
  approximately 8-10 minutes to complete.
• The BSI is used at intake to assess psychiatric
  symptom severity and to measure patient progress
  during treatment.

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BSI Administration

• Instructions
• The BSI test consists of a list of problems
  people sometimes have. Read each one carefully
  and circle the number of the response that best
  describes HOW MUCH THAT PROBLEM HAS DISTRESSED
  YOU OR BOTHERED YOU DURING THE PAST 7 DAYS,
  INCLUDING TODAY. Circle only one number for each
  problem. Do not skip any items. If you change
  your mind, draw an X through your original answer
  and then circle your new answer. Read the
  example before you begin. If you have any
  questions, please ask them now.

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BSI Example Item
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BSI Primary Symptom Scales

• Somatization (SOM) Reflects distress arising
  from perceptions of body dysfunction. Items
  focus on cardiovascular, gastrointestinal,
  respiratory complaints, and other somatic
  symptoms.
• Obsessive-Compulsive (O-C) Focuses on thoughts,
  impulses, and actions that are experienced as
  unremitting and irresistible, as well as
  associated performance deficits.

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BSI Primary Symptom Scales

• Interpersonal Sensitivity (I-S) Assesses
  feelings of personal inadequacy and inferiority,
  particularly in comparison to others.
• Depression (DEP) Reflects a representative
  range of the indications of clinical depression,
  such as dysphoric mood and loss of interest.
• Anxiety (ANX) Concerns general signs of
  nervousness, tension, fear, and panic attacks.

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BSI Primary Symptom Scales

• Hostility (HOS) Measures thoughts, feelings and
  actions associated with chronic anger.
• Phobic Anxiety (PHOB) Assesses persistent fear
  responses to certain stimuli that are irrational
  and disproportionate to the situation.
• Paranoid Ideation (PAR) Concerns paranoid and
  disordered thinking, such as delusions,
  suspiciousness, and hostility.

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BSI Primary Symptom Scales

• Psychoticism (PSY) Measures certain aspects of
  schizoid lifestyle, such as interpersonal
  withdrawal, alienation, and thought control.
• Additional Items There are four items that do
  not belong to a particular scale but are included
  because they possess clinical significance and
  contribute to the global severity measures.

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BSI Global Symptom Indices

• Global Severity Index Provides an overall
  severity index based on the average score of all
  item responses.
• Positive Symptom Total The total number of
  items with a positive or non-zero response.
• Positive Symptom Distress Index Provides a
  severity index based on the average score of all
  positive symptom items.

87
BSI Scoring
88
BSI Scoring
89
BSI Profile
90
Brief Derogatis Psychiatric Rating Scale
91
Brief Derogatis Psychiatric Rating Scale
92
Substance Abuse Treatment Scale

• (SATS)

93
Substance Abuse Treatment Scale(SATS)

• The SATS is a brief clinician rating of the
  clients stage of engagement in substance abuse
  treatment. The clinician rates the clients
  level of engagement on an 8-point scale.

94
Substance Abuse Treatment Scale

1. Pre-engagement
2. Engagement
3. Early Persuasion
4. Late Persuasion
5. Early Active Treatment
6. Late Active Treatment
7. Relapse Prevention
8. In Remission or Recovery

95
Wrap-Around Services Assessment
96
Wrap-Around Services Assessment

• This client-report assessment is designed
• to assist in identifying service needs and
  monitor receipt of service types on a monthly
  basis.

97
Wrap-Around Services Assessment
98
Client Evaluation of Self and Treatment

• (CEST)

99
Client Evaluation of Self and Treatment (CEST)

• The CEST survey consists of items that measure
  areas of client psychosocial functioning and
  perception of treatment. For this project, only
  the eight scales measuring the domains of
  treatment motivation and treatment process will
  be used.

100
CEST Treatment Motivation Scales

• This domain measures clients motivation for
  substance abuse treatment. Treatment motivation
  is a central factor in rehabilitating individuals
  with alcohol and drug problems because it is
  associated with retention and active
  participation in the treatment process.
• Two scales contribute to the Treatment
  Motivation domain.

101
CEST Treatment Motivation Scales

• Desires Help Reflects the degree to which
  clients recognize they have a substance abuse
  problem and desire help.
• Ready for Treatment Assesses the level of
  commitment clients have to participate in the
  current treatment program.

102
CEST Treatment Motivation Scales

• Problem recognition and commitment to the
  treatment process are related but distinct
  components determining treatment motivation. For
  example, clients may be able to identify that
  they have a substance abuse problem and need help
  but also be unwilling to commit to treatment at
  the current time.

103
CEST Treatment Process Scales

• This domain assesses elements of client
  engagement in treatment and quality of social
  network support. Client perceptions of treatment
  needs and participation, therapeutic relationship
  with counselors, and support for recovery in and
  outside of the treatment program are important
  factors in determining retention and treatment
  outcomes.
• The Treatment Process domain is composed of
  six scales.

104
CEST Treatment Process Scales

• Needs More Treatment Assesses the types of
  services that clients feel they need during
  treatment to address individual issues.
• Satisfied with Treatment Reflects client
  satisfaction with the quality of the treatment
  program.
• Rapport with Counselors Measures the degree of
  therapeutic alliance that clients have with
  counselors.

105
CEST Treatment Process Scales

• Participates in Treatment Concerns clients
  perceptions of the extent to which they are
  participating in and benefiting from the
  treatment process.
• Peer Support Measures the amount of support that
  clients feel from other clients in the treatment
  program.
• Social Support Assesses the degree of support
  for recovery that clients feel from family and
  friends.

106
CEST Treatment Process Scales

• High scores on the Needs More Treatment,
  Satisfied with Treatment, Rapport with
  Counselors, and Participates in Treatment
• indicate greater levels of treatment engagement
• suggest that clients are able to identify areas
  in need of treatment, feel comfortable with
  therapists, are actively participating in and
  benefiting from the treatment process, and
• indicate clients are satisfied with the treatment
  experience.

107
CEST Treatment Process Scales

• High scores on the Peer Support and Social
  Support scales
• suggest that clients perceive other clients in
  the program and individuals in their external
  social network as a source of support in the
  recovery process
• indicate that clients have established positive
  relationships with other clients and feel that
  family and friends are supportive of the
  treatment process and recovery

108
Administration of Evaluation Measures
109
Contact Information

• Lori Mangrum, Ph.D.
• Addiction Research Institute
• University of Texas at Austin
• lmangrum_at_mail.utexas.edu
• [phone]