Ethical Use of Assessments

Brian Stracner
COUN5106
8/3/2014
Stehanie !arren
A"stract
Un#erstan#in$ the ethical %se of assessments is a &ital iece of 'no(le#$e alon$ the ath to "ecomin$
a rofessional co%nselor) *his essa+ (ill in&esti$ate the S%"stance A"%se S%"tle Screenin$ ,nstr%ment-
3 .SASS,-3/) *he elements incl%#e# (ill o%tline (h+ the SASS,-3 is rele&ant in the mental health fiel#0
ethical consi#erations re$ar#in$ the a#ministration of the assessment0 an# (hat c%lt%res the SASS,-3
can c%rrentl+ "e ethicall+ %se# for)
Ethical Use of Assessments
Substance Abuse Subtle Screening Instrument-3 (SASSI-3)
One of the most commonl+ %se# assessment tools is the S%"stance A"%se S%"tle Screenin$
,nstr%ment0 (hich is c%rrentl+ in its thir# re&ision .1a%20 Sal+ers0 3 4oto&a0 20055 6+erholt7 3
8osen"er$0 1998/) One of the most interestin$ asects that the SASS,-3 offers is that it is $eare#
to(ar#s filterin$ thro%$h otential fa'in$) :a'in$ can either "e filtere# thro%$h the "a# to $oo#
contin%%m) An e2amle of res%lts that are s'e(e# to loo' too $oo# can "e seen tho%$h someone (ho
(ants to hi#e their a##iction0 or (ho ma+ "e in #enial of their ro"lem) ;o(e&er0 the SASS,-3 also
has an a"ilit+ to filter ans(ers (here the client (ants to "e seen as (orse off than the+ tr%l+ are) *he
SASS,-3 is an assessment0 (hich is con#%cte# thro%$h a self-e&al%ation) *he self-e&al%ation can "e
con#%cte# &er"all+0 on a com%ter0 an# (ith the ol# en an# aer st+le of test ta'in$ .*e2t/) *he
SASS,-3 %tili7es the ai# of s%"-scales to filter s'e(e# res%lts0 an# to hel the clinician create a
treatment lan)
Clinicians (ho imlement the SASS,-3 ha&e the otion to $%i# the articiant into ro&i#in$
information re$ar#in$ the (hole life san0 or an+ 6 month time san (ithin their frame of life) *he
reason for this is to %n#erstan# an+ lon$ term %se0 an# the otential str%$$le a client is c%rrentl+ in)
Another ositi&e asect of the SASS,-3 is the fact that males an# females ha&e "een slit into #ifferent
norms0 (hich sho(s that this assessment meas%re %n#erstan#s that men an# (omen nee# to "e
e2amine# %ni<%el+ in re$ar#s to "iolo$ical an# social constraints .=imeff0 Baer0 4i&lahan0 3 6arlatt0
19995 >om"er$0 1993/) *he act%al SASS,-3 test0 can "e slit into t(o searate ieces of assessment)
*he SASS,-3 assessment "e$ins (ith 6? tr%e or false <%estions .1a%2 et al)0 2005/) *hese
<%estions are not #irect <%estions a"o%t s%"stance a"%se0 "%t instea# foc%s on other facets (hich can
sho( a ten#enc+ to(ar#s s%"stance a"%se) *hese facets incl%#e *he =efensi&e S%"scale0 the :amil+ &s)
Control S%"@ects s%"scale0 the Correctional s%"scale0 an# the 8an#om Ans(erin$ Aattern S%"scale0
*he final ortion of the SASS,-3 foc%ses on s%"scales (hich are o"&io%sl+ relate# to s%"stance
%se .1a%2 et al)0 2005/) A"o%t half of these <%estions loo' for information a"o%t alcohol0 (hile 14
<%estions as' a"o%t other t+es of #r%$ %se) !hen the clinician $oes to interret the #ata0 secific
B#ecision r%lesC are %tili7e# to assess the #ata0 thro%$h a simle B+es0 or BnoC scale)
Theoretical Basis of SASSI-3 in Clinical Mental Health Counseling
*he fiel# of clinical mental health co%nselin$ seems li'e a &er+ $eneral rofession) ;o(e&er0
%n#er man+ circ%mstances f%rther e#%cation0 an# seciali7ations can enhance ones career) *his is not
onl+ imortant for the clinician to for$e a s%ccessf%l ractice or to maintain $ainf%l emlo+ment0 "%t to
also ser&e #i&erse o%lations in nee#) ,n man+ sit%ations teams are nee#e# to hel in#i&i#%als (ith
m%ltifacete# iss%es) ;o(e&er0 if a team has a m%lti-#isciline# rofessional on "oar# the efficac+ of the
team can "e streamline#)
One sit%ation (hich is re&alent in the Northern California area is the iss%e of #%el-#ia$nosis
#isor#ers0 secificall+ (ith in#i&i#%als (ho ha&e mental health an# s%"stance a"%se iss%es) Some
in#i&i#%als (ho s%ffer from mental illness (ill tr+ mana$in$ their iss%es thro%$h s%"stance a"%se
.=%c'(orth 3 :ree#man0 2013/) Certain $ro%s of eole (ho ha&e mental illness ha&e a hi$her rate
of s%"stance %se) Accor#in$ to the National Alliance on 6ental ,llness .2013/0 a recent st%#+ sho(e#
that almost one thir# of all the eole #ia$nose# (ith a mental illness also ha# a s%"stance a"%se
ro"lem) :%rthermore0 almost on half of the eole (ho s%ffer from a se&ere mental illness0 also ha# a
#r%$ or alcohol ro"lem) ,n contrast0 this #+namic is also rele&ant con&ersel+) ,t (as also fo%n# that
more than one thir# of the alcoholics in the st%#+ ha# an %n#erl+in$ mental con#ition0 an# more than
one half of all #r%$ a"%sers also ha# a mental illness) *here are man+ ro"lems re$ar#in$ the clinical
mental health rofessional in re$ar#s to the relation "et(een a #%el #ia$nosis client)
As state# "efore0 the core of s%"stance a"%se can sometimes "e #%e to the clients #esire to self-
me#icate .=%c'(orth 3 :ree#man0 2013/) Sometimes this is #%e to an %n#ai$nose# mental health
iss%e0 or an incomlete #ia$nosis) Unfort%natel+0 (hen eole self-me#icate0 it %s%all+ res%lts in an
e2aseration of the %n#erl+in$ iss%e0 (hich e&ent%all+ can lan# the in#i&i#%al into le$al0 s+cholo$ical0
or h+sical crisis) *he most #an$ero%s times for an in#i&i#%als s%fferin$ from s%ch #%el #ia$nosis is
(hen the+ are into2icate#0 an# (hen the+ are comin$ #o(n) *he hi$hs an# lo(s can create a #an$ero%s
contrast0 enhancin$ the ne$ati&e effects of the mental iss%e)
Ethical Considerations
!hen %tili7in$ the SASS,-30 all of the rele&ant ethical consi#erations m%st "e %hel#) *(o
secific asects (hich co%l# "ecome ethical ro"lems (ithin the scoe of assessment are a%tonom+
an# confi#entialit+) A%tonom+ "asicall+ means that the client has the choice to arta'e in the #ecisions
s%rro%n#in$ the treatment lan) *he ethical iss%e (hich can easil+ arise (ithin this realm0 is the fact
that so man+ eole are %she# into treatment thro%$h the co%rt or other t+e of le$al s+stem .Sil"er 3
Sil"er0 1996/) ;a&in$ eole (ho are force# into assessment for otential treatment ro$rams0 co%l#
#efinitel+ s'e( the #ata from an assessment0 e&en one that tr+ to a&oi# these &aria"les) :%rthermore0 it
(o%l# "e more #iffic%lt to $et an %ncooerati&e in#i&i#%al to hel $%i#e the "est ro%te for their
reco&er+) 6an+ in#i&i#%als co%l# siml+ @%st B@%m thro%$h the hoosC to $et thro%$h the ro$ram0
an# then $o ri$ht "ac' to (here the+ (ere "efore the+ (ere or#ere# into the treatment s+stem) *he
secon# asect is confi#entialit+.Sil"er et al0 1996/) Confi#entialit+ means that (hat haens in a
session is ri&ate0 an# is not to "e share# o%tsi#e of the co%nselin$ en&ironment) *he onl+ (a+ a
clinician is s%ose# to "reach client confi#entialit+ is if the+ "elie&e the client is in #an$er0 a #an$er to
themsel&es0 or a #an$er to other eole) *his is al(a+s tr%e0 %nless the client si$ns a release of
information to share #ata (ith other secifie# in#i&i#%als) Sometimes a co%rt of la( (ill re<%ire s%ch
share# information as a art of ro"ationar+ $%i#elines) *his can "e ro"lematic if all of the aer(or'
is not in or#er to ser&e the client0 "eca%se once a client is in co%nselin$ e&en the fact that the client is in
a ro$ram can "e hel# to the client confi#entialit+ r%le .Sil"er et al0 1996/)
Aroriateness !ith "i#erse $rous
*he American Co%nselin$ Association co#e of ethics .2014/ has a stron$ stance in s%ort of
c%lt%ral sensiti&it+.A)2)c)/ 0 an# contin%e to (or' to(ar#s m%ltic%lt%ral consi#eration .B)1)a)/)
O"&io%sl+0 this transfers to the clinical assessment rocess as (ell) *his is an imortant element to 'ee
in min#0 #%e to the fact that the &ali#it+ an# relia"ilit+ of some tests (ere from st%#ies (hich
re#ominatel+ foc%se# on E%roean Americans .Cremonte0 1e#esma0 Cheritel0 3 Bor$es0 2010/)
Unfort%natel+0 @%st "eca%se an assessment (or's (ell (ith one c%lt%re0 that #oes not mean the &ali#it+
(ill transfer to another c%lt%re) As state# "efore0 the SASS,-3 has "een #i&i#e# into t(o #ifferent
meas%rementsD one foc%sin$ on male a##iction0 the other foc%sin$ on female s%"stance a"%se)
:%rthermore0 another SASS,-3 (as #e&eloe# secificall+ for the hisanic comm%nit+0 (hich sho(s
that research is "ein$ con#%cte# to ser&e #i&erse o%lations .Aitten$er0 2012/) ,n a re&ie( (ithin the
6ental 6eas%rements Eear"oo' an# *ests in Arint0 as o%tline# "+ 6iller .199?/ it (as fo%n# that the
sanish SASS,-3 (as cross &ali#ate# as a %sef%l tool for the hisanic comm%nit+0 "%t it (as f%rther
fo%n# that there (as no si$nificant #ifference re$ar#in$ an+ other #emo$rahic &aria"les) ;o(e&er0
there (as a concern a"o%t ho( certain lin$%istic str%ct%re translate# to other c%lt%res lan$%a$e) >reat
care m%st "e ta'en to translate @ar$on an# c%lt%ral secific lin$o to "e rele&ant an# %n#erstan#a"le in
other c%lt%res)
Conclusion
E&en tho%$h the SASS,-3 is one of the most commonl+ %se# assessment tools to meas%re
s%"stance a"%se0 an# e&en tho%$h $reat care has "een ta'en to ass%re acc%rate an# rele&ant #ata0 there
is still m%ch room to imro&e as far as cross c%lt%ral e2ansion is concerne#) ;o(e&er0 the SASS,-3
#oes ha&e its stron$ oints) ,t loo's ahea# for an+ ossi"ilit+ of s'e(e# res%lts from the self-
assessment0 an# it 'ees in min# the %ni<%eness of $en#er secific a##iction elements) *he SASS,-3
has also "een s%ccessf%ll+ imlemente# into the sanish c%lt%re) ;oef%ll+0 f%t%re research an#
#e&eloment (ill ma'e the SASS,-3 accessi"le to an e&en "roa#er scoe of c%lt%ral #i&ersit+)
8eferencesD
American Co%nselin$ Association .2014/ ACA Co#e of Ethics) 8etrie&e# fromD
httD//((()co%nselin$)or$/reso%rces/aca-co#e-of-ethics)#f
Cremonte0 6)0 1e#esma0 8) =)0 Cheritel0 C) F)0 3 Bor$es0 >) .2010/) As+chometric roerties of
alcohol screenin$ tests in the emer$enc+ #eartment in Ar$entina0 6e2ico0 an# the
Unite# States) A##icti&e Beha&iors0 350 818-825) #oiD 10)1016/@)a##"eh)2010)03)021
=imeff0 1) A)0 Baer0 F) S)0 4i&lahan0 =) 8)0 3 6arlatt0 >) A) .1999/) Brief Alcohol Screenin$ an#
,nter&ention for Colle$e St%#ents .BAS,CS/D A harm re#%ction aroach) Ne( Eor'0
NED >%ilfor# Aress
=%c'(orth0 4)0 3 :ree#man0 F)1) .2013/ 6ental ,llness) National Alliance on 6ental ,llness) 8etrie&e#
fromDhttD//((()nami)or$/Content/Na&i$ation6en%/,nformGEo%rself/A"o%tG6entalG,llness/B+G,llnes
s/=%alG=ia$nosisGS%"stanceGA"%seGan#G6entalG,llness)htm
>om"er$0 E) S) .1993/) !omen an# alcoholD Use an# a"%se) Ner&o%s an# 6ental =isease0 1810
211-219) #oiD 10)109?/00005053-199304000-00001
1a%20 F) 6)0 Sal+ers0 4) 6)0 3 4oto&a0 E) .2005/) A s+chometric e&al%ation of the SASS,-3 in a
colle$e samle) Fo%rnal of Colle$e Co%nselin$0 80 41-51) 8etrie&e# from
httD//((()colle$eco%nselin$)or$/reso%rces/
6iller >) .199?/ S%"stance A"%se S%"tle Screenin$ ,n&entor+-3 .*he/) Hserial onlineI) n)#)5A&aila"le f
romD 6ental 6eas%rements Eear"oo' (ith *ests in Arint0 ,s(ich0 6A
6+erholt70 1)0 3 8osen"er$0 ;) .1998/) Screenin$ colle$e st%#ents for alcohol ro"lemsD
As+chometric roerties of the SASS,-2) Fo%rnal of St%#ies on Alcohol an# =r%$s0 590
439-446) 8etrie&e# from httD//((()@sa#)com/
Aitten$er0 =) .2012/) S%"stance A"%se S%"tle Screenin$ ,n&entor+-3 .SASS,-3/) 6ental 6eas%rements
Eear"oo' an# *ests in Arint)
Sil"er0 *) F)0 3 Sil"er0 =) .1996/) Ethical iss%es in co%nselin$ a#olescents (ho a"%se alcohol an#
other #r%$s) ,n *he ;atherlei$h $%i#e to treatin$ s%"stance a"%se0 art 2 .)1?5-196/)
Ne( Eor'0 NED ;atherlei$h Aress)