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Assessment in specialist alcohol services - adults

Quality statement

Adults accessing specialist alcohol services for alcohol misuse receive a comprehensive assessment that includes the use of validated measures.

Quality measure

Structure:

a) Evidence of local arrangements to ensure that adults accessing specialist alcohol services for alcohol misuse receive a comprehensive assessment that includes the use of validated measures.

b) Evidence of local arrangements to ensure the use of a standardised comprehensive assessment form for adults accessing specialist alcohol services.

c) Evidence of regular local audit of case files for adults in specialist alcohol services to ensure adherence to all assessment domains.

d) Evidence of local arrangements in specialist alcohol services for effective coordination with other agencies relevant to adult service users.

Process

a) Proportion of adults accessing specialist alcohol services for alcohol misuse who receive a comprehensive assessment.

Numerator - the number of people in the denominator receiving a comprehensive assessment.

Denominator - the number of adults accessing specialist alcohol services for alcohol misuse.

b) Proportion of adults accessing specialist alcohol services for alcohol misuse who are assessed using appropriate and validated measures for each applicable assessment domain.

Numerator - the number of people in the denominator assessed using appropriate and validated measures for each applicable assessment domain.

Denominator - the number of adults accessing specialist alcohol services for alcohol misuse.

Description of what the quality statement means for each audience

Service providers ensure they implement validated measures for assessing adults accessing specialist alcohol services for alcohol misuse, and provide a standardised assessment form to ensure that all components of a comprehensive assessment are completed for every person.

Health and social care professionals ensure they complete all components of a comprehensive assessment including the use of validated measures, for adults accessing specialist alcohol services for alcohol misuse.

Commissioners ensure they commission specialist alcohol services that use validated measures for assessing adults accessing specialist treatment for alcohol misuse, and ensure that all components of a comprehensive assessment are completed for every person.

Adults accessing specialist alcohol services for alcohol misuse receive a full assessment of the different areas in which they might need help.

Source clinical guideline references

NICE clinical guideline 115 recommendations 1.2.1.4, 1.2.1.5, 1.2.2.5, 1.2.2.6 (key priority for implementation), 1.2.2.7 and 1.3.2.3.

Data source

Structure

a), b), c) and d) Local data collection.

Process

a)The National Alcohol Treatment Monitoring System (NATMS) collects data on people presenting for structured treatment in specialist alcohol services; ‘triage date' is collected, which is the date that triage/initial assessment took place (this is not necessarily a comprehensive assessment). It also collects data at the start of treatment for the numbers of drinking days in the last 28 days (self-report) and typical numbers of units consumed in an average drinking day. Full assessment requirements contained within NICE clinical guideline 115: audit support criteria 2 and 3.

b) Local data collection. Contained within NICE clinical guideline 115: audit support criterion 1.

Definitions

NICE clinical guideline 115 recommends the following validated assessment tools to assess the nature and severity of alcohol misuse:

  • Alcohol Use Disorders Identification Test (AUDIT) for identification and as a routine (drinking) outcome measure
  • Severity of Alcohol Dependence Questionnaire (SADQ) or Leeds Dependence Questionnaire (LDQ) for severity of dependence
  • Alcohol Problems Questionnaire (APQ) for the nature and extent of the problems arising from alcohol misuse.

The Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar) may be used to assess the severity of alcohol withdrawal.

NICE clinical guideline 115 recommends considering a comprehensive assessment for all adults referred to specialist services who score more than 15 on the AUDIT. A comprehensive assessment should asses multiple areas of need, be structured in a clinical interview, use relevant and validated clinical tools, and cover the following areas:

  • alcohol use, including:
    • consumption: historical and recent patterns of drinking (using, for example, a retrospective drinking diary), and if possible, additional information (for example, from a family member or carer)
    • dependence (using, for example, SADQ or LDQ)
    • alcohol-related problems (using, for example, APQ)
  • other drug misuse, including over-the-counter medication
  • physical health problems
  • psychological and social problems (including housing)
  • cognitive function (using, for example, the Mini-Mental State Examination [MMSE])
  • readiness and belief in ability to change.

Comorbid mental health problems should also be assessed as part of any comprehensive assessment, because many comorbid problems (though not all) will improve with treatment for alcohol misuse.

Any initial assessment, which may take place as a triage or as part of the comprehensive assessment, should also assess:

  • the pattern and severity of alcohol misuse (using AUDIT) and severity of dependence (using SADQ)
  • the need for urgent treatment including assisted withdrawal
  • any associated risk to self or risk to others
  • the presence of any comorbdities or other factors that may need further specialist assessment or intervention.

Equality and diversity considerations

When assessing the severity of alcohol dependence and determining the need for assisted withdrawal, the criteria should be adjusted for women, older people and younger people.

All assessments should be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. People who need a comprehensive assessment should have access to an interpreter or advocate if needed.

This page was last updated: 25 August 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.