Spotlight on the States: Alaska Screening Tool

The Spotlight on the States is a quarterly series designed to highlight valuable resources that have been developed by states to further the integration of mental health and substance abuse systems and services. States highlighted in this series were a part of a SAMHSA-supported learning collaborative and agreed to share their experiences, resources and lessons learned.

The Alaska Screening Tool (AST) is a 2-page questionnaire that screens for substance abuse, mental illness, co-occurring disorders, traumatic brain injury, Fetal Alcohol Spectrum Disorders, and adverse (trauma) experiences. Developed in collaboration with behavioral healthcare providers, policymakers, and consumers, the AST is designed to identify individuals who need to be assessed to determine if clinical treatment is indicated. The tool was refined in 2010. Several states currently use a version of the Alaska Screening Tool.

"One of the things that we learned as a recipient of one of SAMHSA's Co-Occurring State Incentive Grants (COSIG) is that screening and assessment are essential to effective treatment for people with co-occurring disorders," said Mark Haines-Simeon, Policy and Planning Manager at the Alaska Division of Behavioral Health.

In addition to the AST, Alaska also collects a separate set of client data, known as the Client Status Review (CSR), before the individual is assessed and enters into services. The CSR data provides a baseline measure of the person's quality of life. It includes 14 items in four domains — health, safety, productive activity, and living with dignity. The CSR is then administered periodically throughout the individual's course of treatment to monitor progress toward recovery.

To incentivize the application of the AST and CSR, new integrated Medicaid regulations reimburse for both instruments and require clinical application into the assessment process. The principal goal of all these processes and tools — the AST, the CSR, and the client assessment — is to support clinical decision-making by providers. In particular, the CSR allows clinicians to periodically review an individual's progress and, if needed, to adjust the course of treatment to improve outcomes as measured by changes in quality of life indicators.

"If you're a clinician sitting with a client in your office, you're able to access the client's file online, generate a "CSR Change Over Time" report, and review progress together on such objective measures as physical and mental health, substance use, employment and community involvement," said Haines-Simeon. "You can also review progress on subjective measures such as whether they feel that they're getting their needs met and are being treated with respect."

The State and individual agencies produce aggregate reports that profile characteristics, such as prevalence of co-occurring disorders or trauma, and track outcomes across the system and at the agency and client levels. For more information, please contact Mark Haines-Simeon at Mark.Haines-Simeon@alaska.gov.