Tag: SASSI-A3

Registration Open: Adolescent-Community Reinforcement Approach

Courtney Hupp, MSW, LCSW, CADC will be presenting a live webinar on implementing the A-CRA treatment model on November 14th. On December 1st she will be presenting how to implement Family Sessions using this model.

The treatment model known as Adolescent-Community Reinforcement Approach (A-CRA) recognizes that, at least initially, alcohol and drug use is about reinforcing consequences — that make us more likely to repeat actions. This is true whether we are hanging out with friends, playing a favorite game, eating a good meal, or using alcohol or other drugs. People who use alcohol and drugs get something out of it – or they wouldn’t keep doing it.

The overall goal of A-CRA is to help individuals reconnect with or discover new sources of positive reinforcement within their community to compete with alcohol or drug use. How do A-CRA clinicians do this? By listening to and learning from their clients what is important to them. They then help them connect to pro-recovery activities that have meaning and value to their client. In addition, A-CRA clinicians help their clients identify goals and learn how to achieve them. A-CRA clients also learn a variety of new skills, such as problem-solving and positive communication (with partners, friends, and others), which help them attain a better quality of life. Practicing new skills is a critical component of the skills training used in A-CRA. Every session ends with a mutually-agreed upon homework assignment to practice skills learned during sessions. A-CRA clinicians engage caregivers or other family members to support the client and to learn skills that can be used with the entire family.

This intervention has been implemented in outpatient, intensive outpatient, schools, prevention services, and residential treatment settings. This research-tested intervention has been used in over 500 organizations across the United States and Canada. Courtney Hupp will provide an introduction to the A-CRA model, a summary of the research base, and details about how to use a variety of A-CRA skills during sessions.

What You Will Learn:
• An Introduction to the A-CRA model
• History of A-CRA research and implementation
• Goals of A-CRA treatment
• An overview of the A-CRA session structure and treatment guidelines
• How to use some of the A-CRA procedures during sessions like a Functional Analysis for substance use, Happiness Scale, Sobriety Sampling, and Increasing Prosocial Recreation
• General clinical skills necessary to implement A-CRA

FAMILY SESSIONS:
Engaging caregivers and other healthy family members into A-CRA treatment to strengthen social support. A-CRA clinicians help clients and families learn skills that can be used with the entire family. A-CRA skills are simple, behavioral, and easy for families to repeat during the family sessions and outside of treatment. In addition, the positive, supportive approach of A-CRA allows participants to focus on the positive aspects of the family and build upon family strengths to improve the relationship.

On addition to bullets above you will also learn:
• How to use the A-CRA skills during family session. Family session skills include: three positives exercise, relationship happiness scale, problem solving, communication skills, and daily reminder to be nice.

Be sure to register for one or both of these webinars at: www.sassi.com/other-training-online

FREE LIVE Clinical Q&A Registration Open

As discussed in a prior blog, we are expanding our free clinical phone service by offering free live clinical Q&A sessions online. These Q&A sessions are open to everyone. The Q&A will be hosted by our Clinical Director, Kristin Kimmell, LCSW, LCAC, and will last one-hour. We invite you to ask questions or share experiences regarding unusual or difficult profiles you may have come across, but all questions are welcome. You can also join just to listen to the group discussion.

Our first free Q&A session is scheduled for Tuesday, October 4th from 1-2 pm ET. Click here to register today. Due to time restraints, the session will be limited to the first 25 registrants. As new dates are added we will post them to our blog or you can check the registration page via the link above in this blog.

Note that this Q&A does not provide CEUs and is not a substitute for SASSI Training.

We hope you will join us!

Coming Soon: LIVE Clinical Q&A Sessions

Since the release of the original SASSI in the late 80’s we have had the pleasure of providing free clinical consultation and support for those using our instruments via our toll-free phone line. Our clinicians have enjoyed speaking with professionals about SASSI results and strive to make it a useful and pleasant experience. We are planning to expand on this service by offering free live clinical Q&A sessions online. We invite users of our instruments, those considering implementing our instruments, and students, to join our Clinical Director, Kristin Kimmell, LCSW, LCAC, for these FREE live one-hour sessions. Here you will be able to ask questions or share experiences regarding unusual or difficult profiles you may have come across, but all questions are welcome. You can also join in simply to listen to the group discussion and are not required to ask questions.

We hope this will be a useful expansion of our clinical service and look forward to having engaging group discussions. We believe we can learn from you as well and these discussions will help us be sure that our research is up to date with current concerns in the field of SUD. We will be announcing the date, time and registration information for our first Clinical Q&A next month on our Blog so be on the lookout for it!

LGBTQA issues: What side of the Profile Sheet to use in cases where gender is in question?

We receive regular phone inquiries regarding which side of the Profile Sheet to use in scoring either the Adolescent or Adult SASSI when the client identifies as transgender or neither male nor female. This comes up whether one is using the paper and pencil or the online version.

To affirm one’s self-identity can be powerful and empowering so a discussion with a client who is either questioning their gender identification or sexual orientation or is very clear about either one can be a very supportive encounter. The message given is one of sensitivity, respect, and validation for their choices.

As a way of addressing this issue the adult SASSI-4, adolescent SASSI-A3, and Spanish SASSI ask for ‘gender’ in the demographics rather than ‘sex.’ This allows the client to indicate their self-identity. What side of the profile sheet used for scoring purposes should either (1) conform most closely to what the client indicates or (2) after discussion with the client, what they feel most comfortable with given the gender limitations of M/F on the SASSI.  The research is based on binary identification and as such, we are limited in adding additional categories. Future research will undoubtedly be more inclusive. Regardless, the results are valid. The overall goal of the inventory is to give both the administrator and the client a compass to follow with useful information regarding the extent that substance use may or may not be a problem.

To be clear, score the side of the profile sheet that the transgender client self-identifies with. Not when or if they started hormones, or in a current state of transitioning, or they identified as a different gender when the legal offense happened.

A client may express a preference to not identify in any way and decline any gender identification. In that case, the administrator may want to score both sides of the SASSI to see if there is any difference in the result. More often than not, the result will be the same. The primary differences in M/F are in the FVA/FVOD scales which impact Rule 1 and Rule 10 in SASSI-4. There are no differences in the SASSI-A3.

The following is a list of LGBTQA terminology and definitions provided from the Prism Youth Community, part of Bloomington PRIDE here in Indiana:

These definitions were borrowed and adapted from several sources including the University of California- LA LGBT Campus Resource Center, the University of California Berkeley Gender Equity Resource Center, the University of Michigan Spectrum Center, and the University of Wisconsin Milwaukee LGBT Resource Center.

Definitions may vary with location, era, and culture. It is very important to respect people’s desired self-identifications. One should never assume another person’s identity based on that person’s appearance. It is always best to ask people how they identify, including what pronouns they prefer and to respect their wishes.

Ally – Typically any non-LGBT person who supports and stands up for the rights of LGBT people, though LGBT people can be allies, such as a lesbian who is an ally to a transgender person.

Androgyne A person appearing and/or identifying as neither man nor woman, presenting a gender either mixed or neutral.

Asexual – A person who is not sexually attracted to any gender or does not have a sexual orientation. Asexuality is not the same as celibacy.

Bisexual or Bi – A person emotionally, physically, and/or sexually attracted to males/men and females/women. This attraction does not have to be equally split between genders and there may be a preference for one gender over others.

Cisgender – A person who feels comfortable with the gender identify and gender expression expectations assigned to them based on their physical sex.

Gender Expression – The way in which a person expresses their gender identity through clothing, behavior, posture, mannerisms, speech patterns, activities, and more.

Gender Identity – A person’s sense of being masculine, feminine, or other gendered.

Genderqueer A gender variant person whose gender identity is neither male nor female, is between or beyond genders, or is some combination of genders.

Homosexual or Gay – A person primarily emotionally, physically, and/or sexually attracted to members of the same sex.

Intersex – A person whose sexual anatomy or chromosomes do not fit with the traditional markers of “female” and “male”. For example: people born with both “female” and “male” anatomy (penis, testicles, vagina, uterus); people born with XXY.

Lesbian – A female-identified person attracted emotionally, physically, and /or sexually to other female-identified people.

LGBTIQA+  – Lesbian, gay, bisexual, transgender, intersex, queer, asexual or ally, and other identities.

Pansexual – A person who is sexually attracted to all or many gender expressions.

Partner – A significant other in an intimate relationship; a gender-neutral alternative to boyfriend/girlfriend, husband/wife, or other binary-based relationships terms.

Queer – 1. An umbrella term for people who are not heterosexual or cisgender. 2. A reclaimed word that was formerly used solely as a slur but that has been semantically overturned by some members of the LGBTIQA+ community, who use it as a term of defiant pride.

Sex – A medical term designating a certain combination of gonads, chromosomes, external gender organs, secondary sex characteristics and hormonal balances.

Sexual Orientation – The desire for intimate emotional and/or sexual relationships with people of the same gender/sex, another gender/sex, or multiple genders/sexes.

Sexuality – A person’s exploration of sexual acts, sexual orientation, sexual pleasure, and desire.

Trans – An abbreviation that is sometimes used to refer to a gender variant person. This use allows a person to state a gender variant identity without having to disclose hormonal or surgical status/intentions.

This term is sometimes used to refer to the gender variant community as a whole.

Transgender – An umbrella term for a person whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth.

Recent Article Investigating Denial Among Mandated Adolescents

The SASSI Institute is proud to announce our newest manuscript addressing adolescent substance
abuse. The title of this article is Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial. It provides an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers. Part of the data set we collected for The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3, the present study focused on data from 164 mandated teens that participated in the principal study. As in the principal study, these cases were drawn from substance use treatment, criminal justice programs, community corrections, and private clinical practices, among other venues, and all cases were provided by clinicians working within these service settings throughout all U.S. Census Regions.

In addition, we review cases demonstrating high-levels of defensiveness and denial in these mandated teen clients, and ethical ways to break through that barrier towards effective treatment engagement. Finally, we present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. We at The SASSI Institute are very proud of this work, and I want to personally thank my co-authors for making this work possible. The article is available free of charge as it was submitted as an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows readers to copy, redistribute, remix, transform, and reproduce in any medium or format, as long as the original authors are properly cited. You can read this article, as well as other articles related to the SASSI, on our References page.

This article also apears in the Indiana Criminal Justice Association’s, The Comment, Spring Edition.

SASSI Online Tips and Tricks: Volume 2 | Delivery Options

In this edition of SASSI Online Tips and Tricks we highlight setting up a questionnaire and the delivery options. When administering a questionnaire, you have six options. This volume will cover the first five in depth. The last one, SASSI to Go, will get its own volume, so watch for that!

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SASSI Online Tips and Tricks: Volume 1 | Support Materials

In this edition of SASSI Online Tips and Tricks we highlight the documents located under the Support Materials page.  Access the Support Materials through the Account Dashboard’s, My Clients tab. The Support Materials button is to the right of the Administer button. There are four quadrants on the Support Materials page, the top left is for Adult SASSI-4 documents, the top right contains the Adolescent SASSI-A3 materials, and the bottom left is for the Spanish SASSI. The bottom right section provides general information.

Read more

Recent Article Investigating Denial Among Adolescents

The SASSI Institute is proud to announce our newest manuscript addressing adolescent substance abuse. The title of this article is Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial. It provides an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers. Part of the data set we collected for The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3, the present study focused on data from 164 mandated teens that participated in the principal study. As in the principal study, these cases were drawn from substance use treatment, criminal justice programs, community corrections, and private clinical practices, among other venues, and all cases were provided by clinicians working within these service settings throughout all U.S. Census Regions. In addition, we review cases demonstrating high-levels of defensiveness and denial in these mandated teen clients, and ethical ways to break through that barrier towards effective treatment engagement. Finally, we present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. We at The SASSI Institute are very proud of this work, and I want to personally thank my co-authors for making this work possible. The article is available free of charge as it was submitted as an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows readers to copy, redistribute, remix, transform, and reproduce in any medium or format, as long as the original authors are properly cited.

Reviewing an Adolescent SASSI-A3: Vaping Issue

This is an issue that may be turning up in your clinical practice. The caller wanted help with a profile interpretation on a 13-year-old male who had turned in a vaping pen. The school was mandated to do a substance use evaluation as a result. The online report indicated “inconsistencies” in the results so the counselor wanted more information. The client was instructed to complete the FVA/FVOD side for his whole lifetime.

The overall result, based on all the rules being ‘no’, came up with a Low Probability of a substance use disorder. The Prescription Drug Scale was zero. However, the Validity Check Scale was 6 so further evaluation was recommended. Elevated VAL and DEF scores coupled with a Low Probability result increases the possibility of the SASSI missing individuals with a substance use disorder.

Looking at the graph on the profile sheet helps to pull out additional information. Note the very low (below the 15th percentile) OAT and SAT scores. The low OAT can indicate someone who has a hard time acknowledging personal limitations or shortcomings. The low SAT can indicate someone who has a chip on their shoulder, feelings of rejection and hypersensitivity to others. Interestingly, the DEF score is within the norm and does not indicate the student was defensive completing the SASSI. The FRISK score is above average but within the norm and because it is a Face-valid scale, content analysis of those items may be useful. The other Face-valid scales, ATT and SYM with their scores of 1 can also be examined.

The student who turned in the vaping pen indicated it was not his. It was not clear from the caller what substances they suspected were being used. Clinically, the best thing to keep in mind is that the student has a hard time opening up and is probably very concerned about how he is viewed by teachers, counselors, etc. and very quick to feel rejected. Interacting with him in an accepting and affirming way is probably the best approach.

Substance use issues: The VAL of 6 is a red flag so further evaluation with this student is warranted. It could be on-going oversight within the school, i.e. school counselor or referral to a Substance Use counselor who could do a more formal and comprehensive assessment.

We hope this is useful for you.

As usual, don’t hesitate to call the Clinical Helpline at 800-726-0626 with any clinical questions. Live clinicians are available M-F, 11-5 pm (EST). Otherwise, feel free to leave a message and we will get back to you the next business day.

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Interpreting the Results of an Adolescent SASSI-A3 with a High OAT Score

Happy New Year everyone!

I received my first Adolescent A-3 call on the helpline and was so excited and when I heard the numbers, I knew exactly why the clinician was calling.

As you look at the profile, you can see most of the numbers are within the norm. He meets Rule 6 so comes up with a High Probability of a Substance Use Disorder and no Prescription Drug Abuse.  So, what clinical information can the scale scores give you with so few scales outside the norm?

Although the FVOD is within the norm, it is above average and as recommended, you can do content analysis of his Face Valid scales. Another scale to pay attention to is the OAT score of 7 which is elevated. This suggests the client can acknowledge personal limitations and shortcomings and identify with other substance abusers. However, he may not want to or think he can change. The other significant score is SAT with a score of 1 which is below the 15th percentile. This suggests he may be hypersensitive to others and comes across as having a chip on his shoulder. This gives you good information on how to approach this client, especially when giving him feedback as you process the results with him because he is not giving you a whole lot of direct information regarding his use.

A word about the VAL of 6. If the numbers had resulted in a Low Probability of a Substance Use Disorder, you would question the results and do further investigation. Because he met Rule 6, there is no need to address the VAL. That said, with the VAL being so high, was this individual trying to manipulate the questionnaire and didn’t succeed?

Finally, users of the older version will notice that the SCS has been eliminated. This will require your use of the DSM-5 to determine the diagnosis and level of severity from your assessment.

Hope this information is instructive and assists you in your practice. And remember, as usual, we are here to help, so give the clinical line a call at 800-726-0526, press 2.

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