should also be conducted. Comprehensive assessment may be conducted by more than one member of a multidisciplinary team, because different competences may be necessary to assess different areas of client need (e.g. a doctor needs to assess clients for prescribing interventions involving controlled drugs – a supplementary prescriber may also be involved; or a psychologist may need to carry out psychometric assessment).
Comprehensive assessment can be seen as an ongoing process rather than a single event. Comprehensive assessment will be carried out when a client may:
Require structured and/or intensive intervention
Have significant psychiatric and/or physical co-morbidity
Have significant level of risk of harm to self or others
Be in contact with multiple service providers
Have a history of disengagement from drug treatment services
Be pregnant or have children “at risk”.
Comprehensive assessment provides information that will contribute to the development of a care plan for a client.
It is best practice to carry out risk assessment as part of screening, triage and comprehensive assessment. Risk assessment aims to identify whether the individual has, or has had at some point in the past, certain experiences or displayed certain behaviours that might lead to harm to self or others. The main areas of risk requiring assessment are:
Risk of suicide or self-harm
Risks associated with substance use (such as overdose)
Risk of harm to others (including harm to treatment staff, harm
to children and domestic violence)
Risk of harm from others (including domestic violence)
Risk of self-neglect.
If risks are identified, risk management plans need to be developed and actioned to mitigate immediate risk. If a service has concerns about the needs and safety of children of drug misusers, local protocols should be followed, for example if there are concerns about risk of significant harms, social services would normally be involved in further assessment of risk. As with comprehensive assessment, risk assessment is an ongoing process and requires integration into care planning. Issues of risk highlight the need for appropriate information sharing across services and therefore the need for cross-agency policies and plans, and for clarity with a client around the limits of confidentiality.
Models of care for treatment of adult drug misusers: Update 2006
Competences required to conduct assessments
The Drug and Alcohol National Occupational Standards (DANOS)39 outline the basic competences for professionals to undertake different levels of drug and alcohol assessment. Comprehensive assessment is intended to be a multidisciplinary process to ensure a holistic approach to client need. Where a medical intervention is required, such as substitute prescribing or a psychiatric evaluation, the assessment must be undertaken by an appropriately trained doctor.
For more information on assessment, see the Care Planning Practice Guide (NTA 2006).5