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Screening for Island Mental Health Issues and Substance Abuse: An interdisciplinary approach


Title: Screening for Island Mental Health Issues and Substance Abuse: An interdisciplinary approach Author: Gina Tassone Last modified by: Honored Guest – PowerPoint PPT presentation

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Title: Screening for Island Mental Health Issues and Substance Abuse: An interdisciplinary approach

Screening for Island Mental Health Issues and
Substance AbuseAn interdisciplinary approach
  • A project by students of the University of
    Massachusetts Graduate School of Nursing and
    School of Medicine

  • It is becoming clearer and clearer that
    mental health agencies cannot directly and alone
    solve the mental health problems that confront a
    community, and that the mental health system is
    simply a part of the network of community
    agencies which overtly or covertly provide mental
    health services.
  • Milton Mazer, People and Predicaments

  • According to the 2005 Marthas Vineyard Health
    Report, rates of substance abuse and mental
    health issues are higher on the island than the
    national average.
  • Research has shown that people in rural areas are
    less likely to seek help for mental health issues
    than they are for physical conditions.

  • Last years research found that there is a need
    for more screening of mental health and substance
    abuse issues on the island.
  • In addition, only 12-15 of individuals surveyed
    in the Marthas Vineyard Health Report indicated
    that their provider discussed alcohol use with

Research in action, courtesy of Oak Bluffs
  • Screening should be done via an interdisciplinary
    approach, not exclusively by mental health
    workers and Primary Care providers. By
    increasing the number of professionals screening
    for illness, a greater population can be reached.
    Because of this, any screening tool must be
    useful in a wide variety of settings.

Process of Developing the Tool
  • Research was undertaken to look at existing tools
    used by the health care fields and the
    information that was extracted from these tools
    was chosen for its likelihood of applying to
    issues facing the island community.
  • The questions found within this tool come from
    frequently used professional modules and
    therefore have been demonstrated to be effective
    in a variety of settings.

Process of Developing the Tool
  • Alcoholism, substance abuse, anxiety and
    depression were shown to be more prevalent on the
    island than the national averages, according to
    the Marthas Vineyard Health Report.
  • Based upon this data, these four topics were
    chosen to be components of the tool.

Process of Developing the Tool
  • The combined background of the students involved
    in creating this tool included various clinical
    and educational experiences that facilitated
    effective teamwork and a diverse knowledge base.

Marthas Vineyard Comprehensive Screening Tool
Marthas Vineyard Comprehensive Screening Tool
  • The tool is divided into two main segments, one
    screening for alcohol and substance use, and the
    other for depression and anxiety.
  • Each question is weighted and a combined score of
    2 or greater in either of the two main sections
    should result in further evaluation or referral.
    An exception is the two noted questions, which
    should result in immediate referral.
  • The questions asked are based on general signs
    and symptoms of alcoholism, substance abuse,
    depression and anxiety, and are by no means
    diagnostic of any one specific illness or

Companion to the Tool
Interviewing Island Professionals
  • Vineyard Nursing Association
  • Wampanoag Tribal Health Center
  • Rural Health Clinic (PA and Psychiatrist)
  • Elder Services, MVH
  • ER, MVH
  • Substance Abuse Counseling
  • County Sheriff
  • Island Counseling Center

Interviewing Island Professionals
  • Questions for Interviewees
  • Are there methods you use to screen for mental
    illness/substance abuse? If so, are there
    questions you adapt or wish were included in
    these tools? What are the strengths of the tools
    that you use?
  • Do you feel that this tool would be useful to you
    in your role in dealing with members of the
  • Do you think that we should ask patients if they
    feel that they have a drinking or substance abuse
  • What should be included in this tool to make it
  • Do you feel that substance abuse and alcoholism
    can be combined in the same questions (as
    demonstrated by this version of the tool), or do
    you feel that these should really be kept
  • Do you think that this can be used as an
    interdisciplinary tool? Do you feel that there
    should be separate tools used by different
    providers/law enforcement?

Interviewing Island Professionals
  • Feedback from interviews included
  • Keep the tool brief
  • Use simple wording
  • Questions should yield yes/no responses
  • For simplicity, combine alcohol and substance
    abuse questions, but mention both.
  • Keep it general to be used by different
  • Separate alcohol and substance abuse as two
    unique issues.
  • Ask patients directly if they feel that they have
    an issue.

Interviewing Island Professionals
  • This feedback resulted in significant changes in
    the scoring, question type and wording of the
    screening tool.
  • One question that was added as a result of
    feedback related to isolation from society and
    daily activities.

  • Use of the tool should be encouraged for a
    variety of professionals, including medical
    professionals, law enforcement officers,
    counselors, religious officials, and other
    community service providers.
  • The tool must be adapted for use for non-English
    speaking clients (i.e. Portuguese, Spanish).

A Growing Need
  • We feel that there is a grave lack of critical
    resources on the island. If this tool is
    effective, the need for the following resources
    will only increase
  • ? The island desperately needs more
    social workers, mental
  • health counselors and other
  • ? The hospital needs detox programs
    and a crisis stabilization
  • unit as well as psychiatric support
  • ? More support groups must be
    developed, including a Portuguese AA
  • ? Non-English support groups and
    providers are in short supply,
  • especially those catering to the
  • community
  • ? Greater support for and understanding
    of the unique
  • needs of mental health and substance
    abuse populations
  • throughout the island community.
  • ? Continually updated, detailed
    information on referral processes

Opportunities for Future Study
  • A detailed implementation plan for the
    utilization of the screening tool
  • A study of who is using the tool
  • A study of the tool effectiveness
  • A count of the number of referrals made from
    those professionals
  • A study of ways to improve the tool to meet the
    changing needs and diversity of the island

Thank You
  • Cindy Mitchell, Murray Frank, Tom Bennett, Olga
    Church, Terry Appenzellar, Ron Rappaport
  • Suzanne Cashman
  • Rural Health Clinic, Health Care Access Program,
    Island Counseling Center, Marthas Vineyard
  • Interviewees Joyce Cleavenger, Carol Ann
    Lindsey, Betsy Van Landingham, Jacque Cage, Hazel
    Teagan, Michael McCormack, George Cohn, Tom

(No Transcript)
  • Marthas Vineyard 2005 Health Report
  • Mazer, Milton. People and Predicaments.
    Cambridge, MA, Harvard College, 1976.
  • AUDIT screening tool
  • CAGE screening tool
  • Hamilton Anxiety Scale
  • Hamilton Depression Scale
  • Michigan Screening tool
  • Utilization of mental health services in rural
    and remote communities, Journal of Rural
    Community Psychology. Vol. E7, Spring, 2004.