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A Closer Look: Q&A with Jody Brook

Jody Brook, PhD and MSW/LCSW, is a faculty member at the School of Social Welfare at the University of Kansas. In collaboration with professor and associate dean Tom McDonald, and project director, Elicia Berryhill she has partnered with the states of Oklahoma and Iowa on a series of grants totaling $5.75 million over the next five years. One aspect of this funding is to continue implementation and evaluation of a universal screening tool for risk of parental substance use disorders within the context of child welfare. Dr. Brook discussed the screening tool, UNCOPE, with us.

Why is universal substance abuse screening important in child welfare, and how can it benefit families?

About 40-60% of all cases in child welfare involve substance abuse, but practices for identifying these families have not been developed and tested on a large scale, such as a statewide implementation. The earlier a caseworker knows that substance abuse may be a factor in the case, the earlier he or she can begin making steps to ensure that family members receive full assessments for substance use disorders.

Caseworkers often do not have the language or knowledge to screen for substance abuse risk. The UNCOPE universal screening tool gives them this language. It is also beneficial to the public service system to identify substance abuse risk early on; timely assessment and referrals to treatment (if warranted) are important aspects of case planning.

How do you envision this screen being used in child welfare?

It’s important to understand what universal screening is—a measure designed to identify risk. It is not a diagnostic tool; it is a screen for risk. In this case, the UNCOPE identifies those at risk for having a substance use disorder. If identified as positive, the individual is referred for full assessment by a professional trained in substance abuse assessment. For our use in this grant, we wanted to implement a screen statewide within the context of the child welfare family assessment, which takes place at the time of child removal.  We train the child welfare workforce and analyze on a continuous basis how the screen is being used. For example, if a family member has a positive screen, is the worker referring the family for a full assessment?

Can you briefly describe the UNCOPE?

The UNCOPE consists of six questions found in existing instruments and assorted research reports. This excellent screen was first reported by Dr. Norman Hoffmann and colleagues in 1999. The six questions may be used free of charge for oral administration in any medical, psychosocial, or clinical interview. They provide a simple and quick means of identifying risk for abuse and dependence for alcohol and other drugs. The six questions are:

U “In the past year, have you ever drank or used drugs more than you meant to?” (Or as revised “Have you spent more time drinking or using than you intended to?”)

N “Have you ever neglected some of your usual responsibilities because of using alcohol or drugs?”

C “Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?”

O “Has anyone objected to your drinking or drug use?” (Or, “Has your family, a friend, or anyone else ever told you they objected to your alcohol or drug use?”)

P “Have you ever found yourself preoccupied with wanting to use alcohol or drugs?” (Or as revised, “Have you found yourself thinking a lot about drinking or using?”)

E “Have you ever used alcohol or drugs to relieve emotional discomfort, such as sadness, anger, or boredom?”

Two or more affirmative answers signal the need for a referral for a full assessment.

How will the grant money further your goals?

The money will continue to allow us to work on the implementation of the screen and gain understanding about the conditions that often co-exist with positive screens. We will be making sure that the screen is used as it is designed, until the practice is fully integrated into child welfare, and we will be studying to learn more about what else this screen may predict, and how its use impacts the case history.

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