Topic 6: Assessments for Suicide and Substance Abuse {by 6/22}

Post your responses to the Assessment Review Reflection Questions (Likes/Strengths, Dislikes/Weaknesses, Clinical Utility) for the following assessments: (1) Beck Scale for Suicidal Ideation (BSS), (2) Beck Hopelessness Scale (BHS), (3) Short Michigan Alcohol Screening Test (SMAST), and (4) Drug Abuse Screening Test – 10 (DAST-10).

 

Your original post should be posted by 6/22.  Post your two replies no later than 6/24.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

30 Comments (+add yours?)

  1. Madi
    Jun 17, 2020 @ 09:42:26

    1. BSS
    a. As a counselor I like the BSS because the questions are straight forward to the point and that it because very obvious whether or not the client is as risk.But, as a client I would be very annoyed with these questions. For what it is testing for is very obvious. Someone who wanted to hide their suicide or depression could easily do so. The questions just seem so very obvious. I find that this test has clinical utility. But I also think that the client taking this has already either disclosed depression or suicide.
    2. BHS
    a. I like this test much better the BSS. While the questions are obviously correlated to depression it is much less in your face about it. I also like the true and false nature of the questions. The true / false nature also makes it much easier to score and much easier for the person to take. The thing I dislike about it is also the true / false nature of it because some clients might be in the gray area and struggle to choose true or false. I find that this has a great deal of clinical utility. For a client could easily go through these 20 questions and then the counselor could also quickly score it.
    3. SMAST
    a. These questions are very straight forward and to the point. There also seem to be more tangible questions than questions regarding the mental state of the person taking the test. I’m honestly not sure how I feel about that. For it makes the black and white nature of the tests make more sense. There is no gray area if you asked a question of something the client has done. I dislike how the test focuses on others, but it does make sense in the context of drinking. I liked how the BHS and BSS focused on the cognition of the person taking the test. This does have clinical utility for it is easy to take and easy to score.
    4. DAST-10
    a. This test reminded me of something you would be given when you go to your PCP. This assessment only seems to scratch the surface. But assessments like this are necessary. For it give the counselor a starting point. The questions are also very straight forward which matches the content of the questions. For the questions asked are black and white questions which make the yes / no answers. This has a great deal of clinical utility for it is quick and easy to take which also makes scoring almost immediate.

    Reply

    • Althea Hermitt- Mcpherson
      Jun 20, 2020 @ 21:33:33

      Hi Madi, I totally agree with you that the Beck Scale for Suicidal Ideation is pretty straightforward and does seek to address suicidality, the severity, plan, and behaviors of the clients during the past week, I didn’t like though that it didn’t address past suicidal ideations or attempts. It is surely obvious what the test is trying to assess however with such an important topic such as suicide the hard obvious question needs to be asked in order to get real information. It is also very long though and I personally didn’t like the fact that you skip some questions based on answers to the first few questions as additional information could be missed by skipping these questions. I agree with you that there must have been some prior disclosure. Overall though I think its a good scale.

      Reply

    • Trey Powers
      Jun 24, 2020 @ 18:39:37

      Hi Madi!

      I totally agree with you on the issue of gray area when it comes to some of these questions. That was one of my points as well. It seems like these tests were geared for the medical model, where you either have something or you don’t and there is no in between. But in the world of psychology, there is a great deal of gray area that really should be taken into consideration. I mentioned possibly using a Likert scale for these questions, which would hopefully be able to account for the gray area, although it would make scoring more difficult, and may dilute the results in some way.

      Reply

  2. Francesca DePergola
    Jun 18, 2020 @ 22:36:45

    1. Beck Scale for Suicidal Ideation (BSS):

    This assessment is obvious that it is trying to identify whether the client is suicidal. I think its blatancy is a strength being so straight-forward that the client can easily answer the questions in the sense that it’s clear. I think it is also a weakness because the client might be nervous to disclose these intense descriptors and either would not want the chance of the counselor to break confidentiality due to their score and concern. I like how it separates the sections off so that the client can either move on or be more specific with what they answered in the past section. This test has clinical utility because it allows the counselor to be able to see what areas the client is struggling in, the sectioning off parts, and its clear. Since there is such clarity, the counselor can easily identify and score this assessment and be able to communicate it to their client. The client must have shown signs of suicidal ideation for them to be given this assessment, so it would not come as a surprise, but at least the counselor would be able to give more direct and clear information about the results.

    2. Beck Hopelessness Scale (BHS):

    The BHS assessment is interesting in that is not as obvious as what it is trying to identify in the client. I think the way it poses the statements about the future is more subtle and this could be helpful for clients to be more honest with their answers. I think the down part of this test is that although it is subtle, it is also vague. So, for example, there could be endless reasons why it might be difficult for a client to be unable to imagine what life would be like in 10 years. I can now see why this test is better at identifying suicidal behaviors. I like how there are only 20 items to score and that they are simply true and false, but I feel like that may make clients a little indecisive about whether to put true or false if they felt more in the middle about things. This test has clinical utility because it is very easy not only for the client to take but for the counselor to scale it and be able to give feedback and communicate the results to the client in a faster manner. I also feel like since they are true and false answers it is easy to quickly find the answers that might raise concern and go over them and the thoughts and feelings behind it.

    3. Short Michigan Alcohol Screening Test (SMAST):

    I thought this assessment was interesting in that it seemed to focus less on the individual and more on their relation to others, which, I guess makes sense when speaking about substances. I was surprised that there were not a lot of questions about thoughts and feelings, more based on actions. I know this is a “short” version, but I also thought it was interesting to see that it took 4 “Yes” answers to be considered as “potential alcohol abuse.” That might be normal, but since I am not used to looking at instruments, it seemed to be a small number. I do think a strength of this is that is even quicker to take and scale than the BSS and BHS assessments which will allow the counselor to give a quick turn around and less wait for the client, which gives it clinical utility. Aside from that, I do think that it is great it gives a rough outline to the client and their alcohol use, but that the DAST-10 is also extremely recommended. I am not sure if it is common for a client to take multiple assessments for the same concern though, but it will not hurt of course.

    4. Drug Abuse Screening Test – 10 (DAST-10):

    This assessment reminded more of a medical test than a psychological one, which is both a strength and a weakness. I know the medical aspects are important, but like the SMAST, it did not ask much about thoughts or feelings when using drugs which are also important. The 10 items are again, faster to score and give back results, but I feel like they ask too little questions and do not go into depth about possible important aspects of drug abuse. This has clinical utility because it allows for a quick overview of what the client is presenting, but that might not always be the best especially since it is just a yes or no type of test in which there can be a lot of gray areas that are not covered within each item.

    Reply

    • Althea Hermitt- Mcpherson
      Jun 20, 2020 @ 21:43:45

      Hi Francesca, its really interested that you said that this assessment reminded more of a medical test rather than a psychological one, I didn’t think of that but its a very good point. I agree that it’s also easy to score and I also shared the point about variations in answers and the limitations of a yes-no scale. I think in lessening the scale some of the pertinent questions might have been omitted and therefore this may be why it seems incomplete in gathering and assessing drug use and though processing during drug use.

      Reply

    • Madi
      Jun 21, 2020 @ 16:58:50

      Hi Francesca,
      I found myself agreeing with most of what you said. One thing that came to my mind when I was answering was I tried to put myself in the clients shoes and how they would feeling taking it. If I was a client I definitely would be rolling my eyes at the BSS and would rather take the BHS because it was more vague. For the DAST-10, I liked how you phrased that it was more medical than psychological. I felt that I had taken a similar version of that at a PCP appointment.

      Reply

    • Michelle McClure
      Jun 21, 2020 @ 20:26:52

      Hi Francesca. I thought your insight on the SMAST and the DAST-10 were interesting. I think both assessments make great rough outlines as you said for potential client substance abuse issues. I think both assessments would be strong starting assessments for assessing a client’s potential substance abuse issues and I agree if the client scored notably on either that additional assessments would be needed to get a better understanding of the client’s more severe substance abuse issues.

      Reply

    • Haley Scola
      Jun 23, 2020 @ 15:58:43

      Hi Francesca,
      I completely agree on your strengths and weaknesses for BSS. I caught myself thinking this was a win-lose situation based on the intensity and clarity of the questions. In terms of the SMAST and DAST-10 I also pointed out in my description that I thought they didn’t ask enough about cognitions and emotions. I think it could also be considered a strength that it goes into the specific past experiences of the client for optimal clinical utility. This will decrease the likelihood of the client lying to the clinician or other defense mechanisms being displayed. I also thought your description of clinical utilities for the assessments was very insightful from the eyes of a clinician and any possible pro’s and con’s that may come up.

      Reply

  3. Selene Anaya
    Jun 19, 2020 @ 14:31:28

    1. Beck Scale for Suicidal Ideation (BSS)

    The questions are very clear and easy to understand in this assessment. The levels of questions are also a strength because if needed, a client can be asked more intense/specific questions. A weakness could be that it sounds so intense since it is very straightforward, a client may or may not answer correctly. At first, it also looks length, so a patient who may be depressed, may not feel the energy to answer the questions with much thought. If they see that you can skip to question 20, they might alter their answers so they don’t need to answer the whole thing. I thought this would be the longest assessment out of the 4, and it turned out to be the shortest. If the client answers truthfully, the scoring and interpretations can be very clear about the extent to which the client thinks about or has prepared for suicide. Again, the hope is that the client answers honestly. This assessment is definitely best for clinicians to use for clients who have already expressed the ideation of suicide.

    2. Beck Hopelessness Scale (BHS)

    The BHS involves questions that are more applicable to everyday life and the future and it is clear that hope in the future is an important marker. I also like that it gets the client to think situationally because the questions are more specific. The two choices to choose from are also nice to see, especially if a client’s desire to “do anything” isn’t really there. Since the questions require more thought, it could become difficult to choose between true and false. Requiring a yes or no answer without having a middle ground can also leave room for the interpretation to overlook some issues. The ease of scoring can be effective regarding time. Quick scoring allows for prompt communication about the interpretation of the results. It is also clear that the assessment is measuring hopelessness which is exactly what it intends. This assessment could be great for giving to clients who may not have disclosed the ideation of suicide.

    3. Short Michigan Alcohol Screening Test (SMAST)

    The shortness of the test is effective. I also like how it doesn’t seem to attack the individual, most of the questions are very situationally based. An obvious weakness was that the scoring did not include instructions to reverse the scoring for 1, 4, & 5. If it wasn’t addressed, I would have had a borderline alcohol issue addressed. Also, the subjectivity of “normal” feels like an issue. Everyone has different people with different characteristics around them, and what is “normal” for one person, may not be normal for another. I know it is one question but having that be first can impact subsequent responses to the other questions. I think this can be used for individuals who already express a concern for their drinking habits and can give clinicians an idea of which areas of the individual’s life the alcohol habits impact and those areas can be prioritized.

    4. Drug Abuse Screening Test – 10 (DAST-10)

    This assessment had strong questions. They assess more than one area of concern such as any physical symptoms, feelings, and possible impact on relationships. Although it seems basic and surface level, I feel like it is a good first assessment to give out. Again, the yes or no answers can leave room for the possibility of ignoring an important issue if the client doesn’t feel strongly about one or the other. However, this assessment does advise the client to choose the response that is mostly right if they have difficulty with a statement which is a plus. Scoring was simple, but the score chart interpretation seems interesting given that there is a meaningful zero and the score of 0 is the only one that requires no action. This reinforces the idea that it would be a good first assessment to give out if the clinician feels as though gathering this information would be helpful.

    Reply

    • Madi
      Jun 21, 2020 @ 17:02:18

      Hi Selene,
      I really liked your answer to the BSS especially how you mentioned the length and how a person who was already sad and hopeless might not have the energy to take it. I had not thought about that which I think it an incredibly important point hat can be made for all the assessments. Length, content and the client’s mind set all need to be taken in to account which choosing which assessment to give them.

      Reply

    • Michelle McClure
      Jun 21, 2020 @ 20:14:40

      Hi Selene. I really liked the Beck’s Hopelessness Scale and I liked it better then the Beck Scale for Suicidal Ideation because the questions were not as directed at suicide and more directed at a client’s level of depression and hopelessness which indirectly tell us more information on the client’s mental health. A client that scores high on levels of hopelessness is much more likely to be depressed and be experiencing suicidal ideation but this assessment brings that out without being so direct. The weakness I think in the BSS is that the questions are so direct that the client may not answer as honestly as they would the BHS. I thought all the assessments were interesting to take and easy to score which I liked as math has never been my strong suit.

      Reply

    • Trey Powers
      Jun 24, 2020 @ 18:46:39

      Hi Selene!

      I hadn’t thought of a client being depressed and wanting to alter their results so as to be able to skip a section of an instrument. Self-report data is always tricky, as people may have flawed thinking about how they actually are feeling, or may want to present a certain version of themselves, possibly one that is healthier than they actually are. At the same time, however, the client is the expert on themselves, so to try and infer how they are feeling from observation alone would likely not be adequate either. I think it’s a bit of a conundrum that clients are asked to fill out assessments that are self-report very early in the process. On the one hand, it is necessary that we get an understanding of where the client is to provide appropriate help, but on the other, this may be the first impression that they are making on the counselor, which could put pressure on the client to present themselves in a certain way that is not truthful.

      Reply

  4. Althea Hermitt- Mcpherson
    Jun 20, 2020 @ 03:36:17

    (1) Beck Scale for Suicidal Ideation (BSS)
    Likes/Strengths:
    I like that the Beck Scale for Suicidal Ideations is a self-report instrument that identifies and measures the severity of clients’ attitudes, behaviors, and plans to commit suicide during the past week and on the day of the assessment. I think the questions were great as they assessed the clients’ wish and intent to die. After scoring the test a clinician is able to determine a client’s wish and intent as well as a sense of control to carry out a suicidal attempt as well as any factors that may cause them not to. Even though the assessment is 20 questions it probably doesn’t take more than 10 minutes to complete. Also, I think a strength of this assessment is that it evaluates prior suicide attempts and the extent of the attempts. Majority of the questions focused on the desire to die and commit suicide, while some focused on constructing a plan to commit suicide. I like that the test can be administered to various populations because the norming groups were adolescents and adults in inpatient and outpatient settings.

    Dislikes/ Weaknesses: it requires some interviewer training
    I dislike that if question 4 and 5 is zero you skip all the other question and move on to question number 20, because what if you have had frequent thoughts of killing yourself, thoughts of writing a suicide note or making arrangements for after you kill yourself, but during that week in question, you didn’t have any thoughts of killing yourself. It doesn’t assess prior thoughts or ideations that Clinicians would need to be privy to those though processing and would need to gather more information in that regard. I feel like having every client answering all the questions would give a clearer picture of previous and current suicide ideations. I think a 21 item assessment is long and if a client already has reasons why they don’t want to live, why would they care about accurately answering 21 questions that are wordy and confusing.
    If the client admits to any active or passive desire to commit suicide, then an additional 14 items are administered. I feel like this would cause concerns for clients if clinicians start skipping questions, they might change their answer as a result.

    (2) Beck Hopelessness Scale (BHS),

    Likes/Strengths: I like that the Beck Hopelessness Scale is a self-report instrument that is used to assess positive and negative beliefs about the patient’s future within the last week and the day of the assessment. I like that the test asks for education, occupation and marital status as this gives some vital information regarding motivation. The Beck Hopelessness scale will take a short time to complete. The norming group used to complete the assessment tool were individuals who reported or attempted suicide. I like the Beck Hopelessness scale because it has a lot of great questions that assess the clients’ despair and abilities to give up. Clinicians will find it easy to score and interpret due to the score range and the meaning attached to each range of scores.
    Dislikes/ Weaknesses:
    I think a 20 item assessment is too long especially to give to someone that is possibly hopeless. The use of true and false questions only, makes the scale a bit weak as it doesn’t account for variation in the answer from the clients. The scale didn’t focus on social or emotional support available to the clients. I feel like at least one question could be included to assess this.

    (3) Short Michigan Alcohol Screening Test (SMAST),

    Likes/Strengths: I like that this assessment is short and the questions assess alcohol use and dependence. I like that it takes into consideration other people’s feelings about clients drinking. I like that the scale is a shorter version derived from a longer more established scale the MAST. I like that the questions seemed to have face validity. The scoring of the test is easy, where anyone can follow and get an accurate score. I also like that it doesn’t require any training for use. The target population for this screening test is adolescents and adults.
    Dislikes/ Weaknesses:
    I dislike that it is a self-report scale that basically states what it’s assessing, therefore individuals can easily give miss information especially if they don’t want to be told they drink too much. Even though this test only has 13 questions there are other alcohol assessments that have 4 or 5 questions so in comparison it’s too long. The Short Michigan Alcohol screening test assesses alcohol involvement within a wide gap of 12 months and doesn’t discriminate between past and present drinking habits. The scale attempted to define normal in terms of drinking but still was unsuccessful. What does less than or more than most people mean, that statement is not quantifiable and will not derive accurate information. What if when I think about what most people drink I’m thinking about alcoholics then my drinking might not be too far off and therefore normalized in my mind.

    (4) Drug Abuse Screening Test – 10 (DAST-10).

    Likes/Strengths: The Drug Abuse Screening test-10 focuses on identifying the extent of problematic drug use and the consequences. It is used with adults or older youths. The scale can be used as a self-report instrument or interview. The Drug Abuse Screening Test-10 is a shorter version of the 28 items DAST. The screening test is short and easy to complete with only 10 questions. It is also freely available and uses a yes-no scale which is pretty easy to answer and can be completed by anyone with at least a sixth-grade reading level. In order to complete the DAST-10 clinicians required no training, only adherence to scoring and administration guidelines.
    Dislikes/ Weaknesses:
    The DAST-10 doesn’t discriminate between past and present use which I think is a major flaw. Also, the questions are obvious and therefore individuals could fake their results. The scoring being numerical and within a range makes it a bit confusing and it could be misinterpreted. Also, the suggested action based on the response requires additional assessment or further investigations by clinicians, therefore it is unable to stand on its own.

    Reply

    • Yen Pham
      Jun 21, 2020 @ 23:41:58

      Hi Althea,
      I consent with you that the past and present used of clients on drug abuse is not discriminated that is a weakness of the DAST-10. The reason for that I think because when the DAST-10 test focuses on problems over the patient’s lifetime, rather than on current problems. This means the test is less likely to detect alcohol problems in the early stages. Besides, this test is self-report so I think it cannot avoid some clients may be too embarrassed to reveal private details may affect the results as well as the diagnosis and treatments.

      Reply

    • Dawn Seiple
      Jun 24, 2020 @ 12:19:24

      Hi Althea,

      I agree with many of your comments related to the BSS. It does do a good job of identifying the severity of the client’s attitudes, behaviors and plans regarding suicide. To accomplish all that, I also agree it is a little long. For someone that has contemplated suicide this week, these have to be painful questions to answer. Having to go through 20 or 21 questions related to these very dark thoughts would be challenging. I also liked your point about how important the question about prior attempts was. Certainly, a clinician would view the patient’s answers differently if a prior attempt at suicide had already been made. As for your thoughts on not skipping the remainder of the questions if the patient answers 0 to questions 4 and 5, I was thinking the patient should only skip 6-20 if there were no 1’s or 2’s for any of the first 5 questions. Otherwise, I agree they should go on and answer further questions.

      As for the SMAST, I also did not find the term “normal drinker” a helpful measure for assessing acceptable alcohol use. Out of 13 questions, 2 of them used this very subjective term. Alcohol abuse is such a common problem that there is a high likelihood the patient’s peer group and family may also have drinking problems. By using this norming group, a patient could actually feel their drinking was not problematic at all when making such comparisons.

      Reply

  5. Yen Pham
    Jun 21, 2020 @ 11:12:01

    Post your responses to the Assessment Review Reflection Questions (Likes/Strengths, Dislikes/Weaknesses, Clinical Utility) for the following assessments:

    1. Beck Scale for Suicidal Ideation (BSS)
    Strengths/ Clinical Utility

    Beck Scale for Suicide Ideation (BSS), self-report of lifetime suicide attempts, and clinician ratings of suicide risk.
    The strength of this scale, I think that is a brief 21-item scale which helps to identify suicidal individuals provided that they are willing to acknowledge and share their thoughts. The BSS serves as a routine screening for existent suicidal thinking (BSS-Screen) and can also aid in a more extensive exploration of the severity of such thoughts (total BSS score). It can be administered in various settings (e.g., psychiatric-psycho therapeutic care, general medical services, and forensic psychiatry). Also, this scale is appropriate for both inpatient and outpatient settings, can be conducted through interview or self-report, and requires some interviewer training. Finally, BSS provided the internal reliability and good test-retest reliability and good concurrent validity. For clinical utility which is likelihood of improved outcomes from use of test, I think that provides a counselor a better therapy and intervention for clients.

    Weaknesses
    However, this scale is some weak points such as some sensitive questions: “I have brief periods of thinking about killing myself which pass quickly. I have long periods thinking about of killing myself”. Those questions may be uncomfortable for clients when their privacy is exposed. Without a trust for counselors or therapists, clients tend not to answer those questions.

    2. Beck Hopelessness Scale (BHS)
    Strength/ Clinical Utility

    The Beck Hopelessness Scale (BHS) questionnaire consists of twenty true/false questions examining the respondent’s attitude for the past week include present. All the questions in this scale are so clearly and directly to the feelings of clients. BHS has been shown to predict suicide in both inpatient and outpatient psychiatric clients. In other words, BHS allows counselors assess about feelings the future of clients, the future as hopelessness is high risk factor for completing suicide. BHS is useful for clinical utility because this scale provides clinicians to carefully investigate the degree of suicide risk and consider the need for suicide precautions. Administration of BHS scale procedure is recommended too gain a better understanding of the patient’s beliefs about his future, the clinician may wish to compare the pessimistic BHS statements to which the client responds “true” with the optimistic BHS statements to which he responds “false”.

    Weaknesses
    Depending on the clarity of this scale (true/false), there will be a weakness for clients if they feel that the questions in this scale are not really true or false to describe their feelings rather than they are feeling moderate on one of those questions. Also, this scale is self-reported so it cannot avoid some clients may be too embarrassed to reveal private details; various biases may affect the results, like social desirability bias.

    3. Short Michigan Alcohol Screening Test (SMAST)
    Strengths /Clinical Utility

    The MAST Test is a simple, self-scoring test that helps assess if you have a drinking problem. The areas of questions of the MAST test touches so specifically such as it relate to the patient’s self-appraisal of social, vocational, and family problems frequently associated with heavy drinking. It takes a short time to complete the test. For clinical utility, it provides counselors background information of clients which helps counselors may find the causes of drinking problem such as family history of addiction and peer pressure of clients. In the future, counselors help clients with the best therapy.

    Weaknesses
    There are two drawbacks to the MAST test, compared with other alcohol screening tests available today. The length of the test makes it less convenient to administer in a busy primary care office or emergency room setting, compared to the shorter four- or five-question tests available such as the CAGE and the T-ACE Test. The questions on the MAST test also focus on problems over the patient’s lifetime, rather than on current problems. This means the test is less likely to detect alcohol problems in the early stages.

    4. Drug Abuse Screening Test – 10 (DAST-10)
    Strengths/ Clinical Utility

    The DAST-10 is a 10-item self-report instrument that was designed to provide a brief, self-report instrument for population screening. Specifically, this scale yields a quantitative index of the degree of consequences related to drug abuse. The instrument takes short time to report (approximately 5 minutes). So it may be used in the different environments to provide a quick index of drug abuse problems. It can be used with adults and older youth. In clinical utility I think that the DAST-10 appears to be a useful instrument for measuring drug involvement and problems associated with the abuse of drugs other than alcohol

    Weaknesses
    Similarly with the questions on the MAST test, DAST-10 test also focus on problems over the patient’s lifetime, rather than on current problems. This means the test is less likely to detect alcohol problems in the early stages. Also, this test provides the instruction for clients choosing to answer the question only by yes/no it will be hard for clients if they are not really fall in this region.

    Reply

    • Francesca DePergola
      Jun 22, 2020 @ 16:32:30

      Hi Sr. Yen!

      I said very similar things in my post about these four assessments. I think it is interesting when you mentioned the comfortability of the client when answering some of the questions of the BSS. This was a thought of mine as well because when treating a client who is suicidal they might not want to be completely honest with their counselor due to the limitations of confidentiality. I thought the word “trust,” was an interesting point because of the therapeutic relationship was strong and built on trust, the client might be able to be more honest with the counselor. If there is not a strong foundation within that relationship it might be hard for the client to disclose important details.

      Regarding the DAST-10, I did not even realize at first that some of the questions focused more about what had happened overall then what is currently happening in the present. Great points!

      Reply

  6. Michelle McClure
    Jun 21, 2020 @ 20:00:56

    1. Beck Scale for Suicidal Ideation( BSS)
    Strengths- This assessment is a very direct way to measure a client’s suicidal risk, beliefs and possible planning. The assessment asks questions about prior suicide attempts and severity which is important to consider in the larger picture of a client’s suicidal risks. Another strength of the assessment is that it does not take that much time to complete which is important since sessions with clients are typically not that long.
    Weaknesses- This assessment is so direct that some clients may find the questions too forward and intimate and may not want to take the assessment or may not answer the questions honestly. A client’s level of honesty makes a huge difference on the potential outcomes of therapy so this is an important consideration when choosing this assessment.
    Clinical utility- This assessment is easy enough to score quickly and can be administered in many different clinical settings including inpatient and outpatient treatment centers.

    2. Beck Hopelessness scale (BHS)
    Strengths- I found I liked this assessment better than the BSS because the questions were not quite as direct yet were very good indicators of where a client is at mentally. The questions were very good indicators of the level of hope vs hopelessness that a client may be feeling and it is well known that client’s that have hope have better outcomes so that is important information for a clinician as there are many interventions and treatments that can help a client feel more positive and hopeful.
    Weaknesses- I really do not think this assessment has any real weaknesses I guess the true/false could be replaced by a measurement scale rating the severity of the feelings of hopelessness but I am not sure that truly constitutes a weakness in the assessment.
    Clinical utility- This assessment is also easy to score quickly, even quicker than the BSS. I personally found this to be a very easy assessment to score and I also feel that is also another strength of the assessment. This assessment is also easy to administer and the client can complete it quickly which as well as being another strength also makes the assessment valuable in many clinical settings including inpatient and outpatient treatment centers.

    3. Short Michigan Alcohol Screening Test (SMAST)
    Strengths- I liked how the assessment asked the client to look at long term drinking patterns over the last year and give really simple yes or no answers about their alcohol use. The assessment is also quickly completed and easy to score which are also strengths. I also liked how the questions were direct and covered a client’s alcohol various settings including social and professional.
    Weaknesses- This assessment asks direct questions related to a client’s drinking habits and even though that is a strength it is also a weakness as it is so direct that a client may not feel comfortable answering the questions honestly and that would be a problem because a clinician can only provide the correct treatment for a problem the client is honest about. Another weakness of this assessment is it is limited to alcohol use and does not ask about other substance use.
    Clinical Utility- This assessment like the others is easy to administer and score which makes it valuable to clinicians in many different mental health settings. This assessment measures alcohol use and would be useful in substance abuse and recovery programs.

    4. Drug Abuse Screening Test (DAST-10)
    Strengths- The strengths of this assessment are that there are only 10 easy to answer yes or no questions. The questions are direct and easy to understand and answer and even though there are only 10 of them they cover multiple areas of functioning including interpersonal relationships, medical, and personal experiences and feelings. I also liked that the inclusion of scoring with a meaningful zero which indicates no clinical intervention is needed.
    Weaknesses- This assessment also does not really have significant weaknesses. The questions are direct which means that the client could choose to not answer honestly but that is a general weakness I have found on these assessments.
    Clinical Utility- This assessment like the previous assessments is simple to administer and score which make it a useful assessment in a variety of mental health settings. This assessment measures drug abuse which makes it helpful in substance abuse and recovery programs.

    Reply

    • Yen Pham
      Jun 22, 2020 @ 00:16:27

      Hi Michelle,
      I like your clear and insightful on the Short Michigan Alcohol Screening Test (SMAS). I agree with you on the strength of the SMAS such as need a quick time to complete, easy to score the test as well as clients’ alcohol various settings. Also, I agree with that the SMAS test is weak whenever a client may not feel comfortable answering the questions honestly because of they are directed to the private life of clients. You also highlight the limitation of this test when it only tested on alcohol use and does not ask about other substance use that I do not mention on my post. However, in my opinion I think there is another weakness of this assessment is it is not refers to clients’ use at the present and earlier but only refers to the past 12 months. This means the test is less likely to detect alcohol problems in the early stages. Finally, this test provides the instruction for clients choosing to answer the question by yes/no, it will be hard for clients to decide if they are not really falling in this region.

      Reply

    • Francesca DePergola
      Jun 22, 2020 @ 17:13:45

      Hi Michelle!

      I also agreed with most of what you said about the suicidal and substance abuse assessments. I thought it was great that within your explanation of their clinical utility, you mentioned the environments in which they could be helpful which is something I did not add within my post.

      I also think the true/false yes/no assessments are great in the way that they are direct, but unfortunate that there is a lot of grey area. I think in some situations clients can feel torn about whether to put true/false yes/no and just one of those answers within the small item assessments can be very influential with results and communication to clients about a counselor’s concerns. This is why it is so important to go over the assessments with clients because they might admit to having difficulty choosing which answer to put and the assessment can be reevaluated in that way,

      Reply

  7. Trey Powers
    Jun 22, 2020 @ 18:40:11

    1. Beck Scale for Suicide Ideation
    Strengths/Weaknesses
    I like how this assessment covers a broad range of the major red flags of suicidality. The instructions are short and clear, as are the possible responses. It also seems beneficial to have the ability to skip a large portion of the instrument if you answered 0 to the first group of questions so as to not take time away from a person who is likely not suicidal.
    I wonder if by skipping a large section of the instrument, even if the person scored 0 on the first section, might pose some risk for false negatives.

    Clinical Utility
    This instrument is very straightforward, both in terms of administration and scoring. As such is it easy to fill out and easy to interpret. It also hits the main elements of suicidality. As such, it can likely be administered to any population for assessment of suicide.

    2. Beck Hopelessness Scale
    Strengths/Weaknesses
    The statements are clear and easy to understand. The option for making only a true or false statement makes the instrument simple to score, especially given the key that is provided.
    I struggled with a number of the statements because of how absolute they were, as well as either indicating true or false was. I felt in the middle on a number of the statements, either not completely agreeing/disagreeing, or feeling as though things happen sometimes but not all the time. I think I would have preferred a Likert scale.

    Clinical Utility
    I think this may pose some problems for populations/people who are more focused on living in the moment without necessarily thinking forward in their life. That being said, the instrument is easily understood and scored, and will likely work well for a wide variety of populations.

    3. Short Michigan Alcohol Screening Test
    Strengths/Weaknesses
    The questions were all relevant to the main problems associated with alcohol abuse. In this case, the yes or no answer format worked well, I believe. The instructions for taking the instrument, as well as for scoring, are simple.
    Apparently they did not include the reversed items in the scoring instructions. Also, I think that certain items, such as seeking help or attending AA should not be signs of a problem, but signs that the person is taking steps toward helping themselves.

    Clinical Utility
    This is a short, easily understood instrument that overall seems to capture what it is to be dependent on alcohol. I believe that this can be used with all populations. It would have been nice that the instructions included the reversed items to accurately assess the data.

    4. Drug Abuse Screening Test-10
    Strengths/Weaknesses
    This instrument is short and to the point. The instructions are detailed in terms of what drug use is, as well as examples of drugs that could be abused. The scoring is also very simple, and includes the reversed items.
    I think that the way the questions are phrased may cause some confusion for a non-drug user. I know that they made note of what “drug use” is in the instructions, but for someone who takes prescription drugs as directed, a few of the questions caught me off guard because of a disconnect between the instructions and the questions. Additionally, there was no N/A option, which seems to restrict the use of this instrument to only confirmed drug users.

    Clinical Utility
    Although easy to answer and score, this instrument still has some confusion surrounding it in my opinion. I feel as though the questions could be rephrased to be clearer in indicating that the drug use is *inappropriate* use. Additionally, this instrument does not seem like it would work well with people who do not abuse drugs, as the questions are written with the assumption that the person is a user. As such, only the drug user population would be appropriate for this instrument.

    Reply

    • Selene Anaya
      Jun 23, 2020 @ 22:26:54

      Hi Trey!

      I like how you mentioned the possibility of false negatives for the BSS. I also had this concern and failed to mention it in my weakness section. Even though Dr. V says that most clients answer honestly, I still think that some may alter their responses to either avoid answering more questions if they are already depressed and unmotivated. They also may relate to the deeper symptoms/ideations that are covered in the more specific section and be unable to identify with the more simple statements in the beginning. For the BHS, I also felt as though I was in the middle of a lot of the statements, and I mentioned that in my weakness portion. Only two choices can also lead to possible false negatives because if an individual is stuck on a question, he/she can choose false when they really lean more towards true. I can see how this could be less of an issue for the SMAST. I had an issue with the term “normal” for that assessment. Different individuals can have different perceptions of “normal” and one is more likely to answer that they deem their behavior as normal especially if they are in denial or unable to accept their issue. I agree with you in that the DAST-10 should be more clear about inappropriate use, however this could result in the same issues I explained for the SMAST regarding what one believes to be “inappropriate”.

      Reply

  8. Dawn Seiple
    Jun 22, 2020 @ 19:14:20

    Beck Scale for Suicidal Ideation (BSS)
    Likes/Strengths -This assessment uses very direct questions that might be easier to raise in a self-report assessment than in a face-to-face interview. It comes at suicidal ideation in a few different ways by asking about desire to die, reasons for living and saving oneself. Each question has a slightly different emphasis. Questions 6-20 are slightly more nuanced and seem helpful in determining how committed the patient is to suicide.

    Dislikes/Weaknesses – The questions are so direct that there is no allusion about the intent. The patient needs to be in place where they are willing to reveal that they are having suicidal thoughts and get into the details of those thoughts. There is no easing into it. Also, if a patient saw that if they answered 1 or 2 for questions 4 or 5, they may simply put 0’s in order to avoid the subsequent questions.

    Clinical Utility – This test seems like it would be a good test for patients who are actively thinking about suicide and who want to express those thoughts. If the patient is in a voluntary therapeutic setting, they would hopefully be looking for help and would be willing to answer these questions honestly. It seems easy to score and interpret and could clearly inform a treatment plan.

    Beck Hopelessness Scales (BHS)
    Likes/Strengths -This test is less direct than the BSS and focuses more on the patient’s outlook and level of hopelessness which many patients may be more comfortable with. As a result, they might be more honest than on the more direct BSS. The patient’s answers actually reveal more than the patient realizes.

    Dislikes/Weaknesses – The test is a little absolute. I think these questions might be better if they were not dichotomous. For example, “My past experiences have prepared me well for the future.” In an uncertain environment like the one we are in, some people might feel the future is somewhat vague and uncertain. They may not feel comfortable with true or false. This outlook would not necessarily reflect hopelessness. Some of the other questions were not strong enough indicators of hopelessness as I thought they could be. “I have enough time to accomplish the things I want to do.” I think people who have a lot of interests probably do not have enough time to accomplish everything they want to.

    Clinical Utility – The test is easy to score and gives the therapist an idea of the patient’s current outlook. The questions provide some areas to discuss and to target in treatment. In order to know if a patient were prone to suicide, it seems more training would be needed to really understand the score.

    Short Michigan Alcohol Screening Test (SMAST)
    Likes/Strengths -It addresses alcohol use and abuse in a number of ways. It asks both objective (Have you ever been arrested…?) and subjective questions (Do you feel that you are a normal drinker?). It is short and gives helpful information without an extensive questionnaire.

    Dislikes/Weaknesses – Because some of the questions are subjective, patients with alcohol problems may not realize they are not normal drinkers depending on who they spend time with. People whose family and peers are heavy drinkers may find their behavior “normal.” Patients who are in denial about their drinking may also not recognize that they can’t stop or that their trouble at work is related to their drinking. The assessment requires that the patient is somewhat introspective and ready to discuss their drinking honestly.

    Clinical Utility – Once you reverse questions 1,4 and 5, the scoring is easy and not difficult to understand. Given the concerns I raised about the test, if patients are scoring 4 or more points, their alcohol consumption should definitely be discussed and more fully explored with a longer assessment and further discussion.

    Drug Abuse Screening Test -10 (DAST-10)
    Likes/Strengths – It provides a short, direct self-report test to address drug use and potential abuse. If the patient is honest and objective about their drug use, it is a helpful screening tool without a lot of overhead related to administering or scoring.

    Dislikes/Weaknesses – As noted, it does require that the patient be honest and objective in their answers. If they are not, it won’t be very revealing. It does not address current frequency of use or trending related to use that also could be helpful.

    Clinical Utility – It is quick and easy to score and doesn’t require a lot of training. Any patient scoring greater than 5 clearly does require more inquiry and probably treatment.

    Reply

    • Haley Scola
      Jun 23, 2020 @ 15:50:00

      Hi Dawn,
      I thought your statement about the differential perspectives of the questions on suicidal ideation (desire to die, reasons for living and saving oneself). I thought it was very helpful and was a point I didn’t fully notice before. For the weakness of BSS, we both said the intensity of the questions require the client to feel extremely comfortable, which is where rapport becomes very important. In context of the BHS test I completely agree with your point referring to the client not knowing how much the test actually reveals which I think is extremely beneficial in the honesty of the clients answers for the assessment. I thought your explanation of weaknesses for BHS was perfect. I was thinking the same thing but didn’t know how to put it into words. You worded it perfectly and I agreed completely. Your explanation for SMAST was very insightful on the points that this test does not acknowledge (or work) with the patient being in denial. Your conclusions of all 4 of these assessments were very insightful and well thought of.

      Reply

    • Selene Anaya
      Jun 23, 2020 @ 22:36:23

      Hi Dawn!
      I liked the point you made about what each section for the BSS is assessing. I also thought it was interesting that they designed the assessment so well and to the point that there is a clear idea of what each section is assessing for. I agree with you that for this assessment, it is important that the clinician knows the client is ready to reveal their suicidal ideations and ready to face the direct statements the assessment includes. I do think the BHS was more comfortable to take, but I wonder if the comfort is able to be differentiated between a suicidal, hopeless individual. I also had reservations about the true/false choices. I mentioned in my discussion that this could be a risk factor for possible false negatives. If an individual is asked between one or the other with no in-between and they choose the wrong one, it has the potential to be significant. I also had a problem with the subjectivity of the SMAST. Your dislikes were exactly like mine, and I think they are all very valid points to be made. I’m curious to hear what Dr. V has to say about it!

      Reply

    • Brigitte Manseau
      Jun 24, 2020 @ 21:50:59

      Hi Dawn,
      In regards to the SMAST, I found the term “normal drinker” to be problematic too. It seemed like the test did not take into consideration how clients may interpret the term incorrectly. Like you mentioned individuals who are surrounded by others who heavily drink would most likely view their own heavy drinking habits as normal. I feel as though the explanation of a “normal drinker” should have included a number of drinks per week. If the term was quantifiable, it may lead to a better understanding of the term as well as more accurate responses.

      Reply

  9. Haley Scola
    Jun 22, 2020 @ 19:43:06

    BSS
    The strength for this assessment is its clarity. The questions are straight forward and get to the point. As a win-lose situation I think a weakness is the intensity of the questions. The assessment requires the client’s honesty and for some questions they client may be nervous (or just hard to admit out loud) the severity level. Three items assess the wish to live or the wish to die and two items assess the desire to attempt suicide. In terms of clinical utility, the assessment is measuring suicidal ideation. If the client answers those 5 indicating they have an active desire to commit suicide, then 14 additional items are asked.I think it is very helpful for insight on the severity of the clients suicidal ideation.

    BHS
    A strength of this assessment is the clear answer key guide in which the client must answer to measure hopelessness. I really like this assessment set up because I think its straight forward in the way its set up. I think a weakness is the True/False answering. Although this makes it easier to administer and grade, I think that sometimes a client isn’t completely a yes to a question or completely no to a question. Because of this, I question the reliability of this assessment. This assessment is measuring hopelessness on a scale of 1. No hopelessness 2. Minimal hopelessness 3. Moderate hopelessness. They may not be in immediate danger but require frequent monitoring. And 4. Severe hopelessness and a strong potential for suicide. So this test if measuring hopelessness but in the terms of if they are a risk for suicide. I find this test clinically beneficial because the client may not even specifically know you’re measuring suicidal ideation at the same time you’re measuring hopelessness.

    SMAST
    A strength of this test is the questions revolving the client’s accountability to the situation. For example, have you ever been in a hospital because of drinking? This is a yes or no answer although the client may be inclined to believe they don’t have a problem. A weakness is the question material. It caught my attention that these questions ask more in relation to how it may affect others in your life or if you’ve gotten in trouble at work. Rather that the person’s cognition or emotions about drinking. This may also be helpful since alcoholics may not be completely aware of their dependency on the item and have the mentality “I can stop whenever I want”. So this may be a weakness but could also be considered a strength. The clinical utility is in order to assess alcoholism. Although it isn’t really measuring dependency, its giving the clinician clear and helpful information of the clients past history on the subject.

    DAST-10
    This test reminded me of the SMAST in which it seems not to measure on cognition or dependency but rather clear facts. A strength of this assessment is how short it is. It’s easy to keep the client focused for the short amount of questions and you can go in depth about these questions afterwards. A weakness of this assessment is that if the client does have a problem but does not want to stop or be labeled as a drug abuser, they can simply lie. For example, “have you neglected your family because of your use of drugs?” The client could define neglect as leaving your house for days on end but as a clinician we would define neglect as even using some of your rent money for drugs or stealing something small from your family in order to pay for drugs. I think the questions could’ve been clearer. Another example is “are you always able to stop using drugs when you want to?” The client could think they can stop whenever they want not see the dependency. This test measures drug abuse and in terms of clinical utility I think it could be helpful in taking the first step towards recovery and allows the client for self-reflection.

    Reply

    • Brigitte Manseau
      Jun 24, 2020 @ 21:43:21

      Hi Haley,
      I liked the weakness you pointed out in regards to the DAST-10. I had not thought about how the client could interpret the various questions for this particular assessment. It’s tricky when some questions rely on the client’s perception of something instead of relying on something that is quantifiable. Some clients may have a distorted view of what certain key words mean like neglect which would throw off their answers. I feel like your point really drives home how important it is to not rely on just one assessment. Clinicians should ask questions and dive a little deeper outside of the assessment to ensure that they understand what’s going on with their clients.

      Reply

  10. Brigitte Manseau
    Jun 22, 2020 @ 21:20:49

    1.Beck Scale for Suicidal Ideation (BSS)

    A strength of the BSS is that it is thorough. The BSS assesses the client’s thoughts of suicide, possible plans/preparations, and previous suicide attempts. I liked that the scoring guideline mentioned how a positive answer to any of the questions should be looked into by the clinician. It reinforces the importance of detecting any suicidal thoughts and/or behaviors. With the scale being straightforward it is clear that suicidal ideation is being assessed. If a client did not want to indicate their suicidal thoughts it would be easy for the client to choose answers indicating that they are not at risk. Also, the candid nature of the scale may intimidate or make the client feel very uncomfortable. Therefore, the client could answer the questions dishonestly. Another weakness is that the BSS is effective with clients who are able to acknowledge their suicidal thoughts. If a client is not at that point of awareness, a scale with more vague statements/questions would be a better fit. I feel like this assessment relies on the honesty and awareness of the client.

    2. Beck Hopelessness Scale (BHS)
    I like how the statements are vague compared to the BSS. The statements aren’t as blatantly assessing suicide therefore it may be more comfortable and easier for the client to answer honestly. The client fills out demographic information on this scale. The information can be used to see if the client has any risk factors relating to suicide. It also can indicate some protective factors of the client such as being married or employed. There are 20 questions and they all are true or false which makes scoring easy. Also, with the scale being true or false it is quick for clients to fill out. The only weakness I can think of is related to the scale being true or false. Clients may have difficulty choosing their answer if they view the statement as somewhat true and false. The BHS would be an appropriate test to give to clients who haven’t communicated suicide ideation. If the client has, the BSS would most likely be a better fit for the individual.

    3. Short Michigan Alcohol Screening Test (SMAST)

    With 13 questions the test is relatively quick for clients to fill out and quick to score. I like how the administration and interpretation instructions strongly suggest that SMAST should be used along with DAST-10. I imagine it is a friendly reminder especially for beginning counselors or, counselors who do not use the SMAST frequently. I liked how the instructions encouraged clients to answer with whichever answer is mostly right if the client gets stuck between choosing yes or no. Thanks to the y/n nature of the rest it was easy to score and interpret my results. However, I did not like that the instructions did not include that the scorer needed to reverse questions 1, 4, and 5. Had Dr. V not mentioned that I would’ve scored myself wrong. In regards of weakness, I was thrown off by the scale using the term “normal drinker.” It does not refer to a definitive amount of alcohol consumption. For two questions the scale relies on the client’s perception of what a normal drinker is.

    4. Drug Abuse Screening Test – 10 (DAST-10)
    Again, I liked how the answers are straightforward which are either a yes or no. I also liked the fact that within the instructions it went over the various drug classes and examples of each. With marijuana being legal in Massachusetts, I feel like some individuals do not take marijuana use seriously. It’s a good reminder to clients that marijuana is not excluded in drug use assessments. The DSAT-10 gives the counselor a taste of what the client’s drug history looks like within the past year. With 10 questions the test is quick to score and interpret the results. A weakness of the test is that it would be easy for a client to not indicate that they’re at risk. I believe that’s one of the issues when assessment are extremely straightforward.

    Reply

    • Dawn Seiple
      Jun 24, 2020 @ 13:25:54

      Hi Brigette,

      I agree that the BHS is a more appropriate test for clients who have not communicated any suicide ideation. If a client has actually revealed such thoughts, it would be important to assess how likely a suicide would be using a more direct tool such as the BSS. Certainly any definitive plans would indicate the need for more immediate intervention.

      I think you raise a very good point about the DAST -10 and the importance of it explicitly including marijuana in the definition of drugs. I definitely agree that because marijuana is now legal in Massachusetts, many people do not view it as a drug for the purposes of such a questionnaire. I especially find this to be the case for teenagers and young adults who have come of age with legal marijuana, either medicinal or recreational. Because marijuana is also not addictive in the purest sense of the word, many people don’t believe it can be abused.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Adam M. Volungis, PhD, LMHC

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 58 other followers

%d bloggers like this: