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Eligibility, intake and assessment

A review of your service's eligibility, intake, and assessment policy and practice will identify if people with complex needs are inadvertently screened out at any of these stages when trying to access drug and alcohol treatment at your service.

Questions for your service to consider

The following questions provide a brief guide to what to consider when reviewing organisational practice:

  • What are your service's requirements for eligibility, remaining on the waiting list, intake and assessment and what is the rationale behind these requirements?
  • What documents and supporting information are required to access your service?
  • Does the eligibility criteria and assessment process communicated to the public reflect your service's practice?
  • What referral practices are in place across your service for those who don't meet the entry criteria?

The table below gives examples of common service eligibility criteria and assessment practice that may inadvertently screen people with complex needs out of receiving drug and alcohol treatment at the eligibility, intake and assessment stages. It offers improved practice strategies founded on a strength-based approach, universal communication practices and the principles of access and equity.

See Practice Tips for Workers for information on supporting criminal justice clients in your service.

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Improving eligibility, intake and assessment practice

Common PracticeImproved Practice

People calling at a set time on nominated days to show motivation and maintain a waiting list place.

This can be problematic for :

  • People in prison preparing for release. Consistent access to a phone is difficult and is beyond the control of the person.
  • People with a cognitive impairment who may have memory issues.
  • People who live in disadvantaged circumstances.

Be flexible about how potential clients can maintain a place on a waiting list.

If the person indicates that they're in prison, you could place them on a waiting list or allow for flexibility in when they can contact you/how often they are required to contact you.

If the person has contact with formal or informal supports you could take any details provided as a possible point for assertive follow-up. A quick phone call may help you find out for example, that the prison has been in lockdown or that they had no phone money to make the call.

For people with a suspected or confirmed cognitive impairment, check with the person each time you talk to them that they have a reminder in place to make their next appointment or call. Their support person may also be able to help with reminders and appointments.

People having to participate in (face-to-face or phone) intake and assessment processes without a support person.

This can be problematic for people with a cognitive impairment who may not understand the questions and /or have memory issues.

Consider if the person will benefit from having a formal support person involved and ask them if they'd like this. This may be a case worker or support worker from another service.

Partnerships and co-case management with other support services can be key to supporting a person with complex needs in treatment.

Identification (ID) requirements.

This can be problematic because:

  • Many people don't have access to ID, or it may carry a significant financial cost.
  • A person's inability to source/afford all ID can sometimes be interpreted as the person not showing enough motivation to be allowed to access and receive drug and alcohol treatment.

Think about the type and amount of ID your service asks for, why it is needed, and how you communicate this to the public.

Be mindful of what is reasonable to expect a person to supply for ID requirements to access drug and alcohol treatment services. Often service ID requirements can exceed those required to access public services such as Centrelink.

Consider the following when reviewing ID requirements:

  • The cost of obtaining the ID you are requesting and implement low or no cost ID solutions to assist access.
  • The amount of time it may take to obtaining ID and how long this may delay access to treatment. Timely access to treatment can be a key aspect of engaging a person successfully.
  • Alternative forms of ID that a person may be able to access easily without significant cost or time.
  • How your service advises people on how to access the different types of ID.

Providing a criminal history/record.

Many services ask for a person's criminal history when considering eligibility for programs. This may only apply to those who disclose a criminal history or to all clients accessing the service.

Think of other ways of gaining the information you may require that is relevant to your service or the person's treatment.

Review why your service requires knowledge of a person's whole criminal record/history, how it will be used and interpreted, and whether the specific information required can be obtained another way. For example, your policy may be to exclude people convicted of arson. Can you find out this specific information without needing a person to obtain their whole criminal history and having information not relevant to treatment on file?

Consider the financial cost of obtaining a criminal record for the individual or service and check if the information required can be obtained another way.

If a criminal record is used, think about who is interpreting the information, if they are trained to do so, if the context of any situation of concern is known by or discussed directly with the client, and if this information could be obtained another way.

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Screening and assessment for cognitive impairment

The 2009 Department of Health and Ageing Guidelines for Treatment of Alcohol Problems recommend as a standard of care that screening for cognitive dysfunction is carried out when a clinician suspects a cognitive impairment and that a referral to a clinical psychologist or neuropsychologist may also be required (Haber et al 2009).

The following questions provide a brief guide for reviewing cognitive impairment screening and assessment tools:

  • What tools are right for our service? (e.g. cultural safety and appropriateness, level of detail required, and treatment planning benefits)
  • What staff training is required to administer and/or interpret the results of the screening tools?
  • When should the tools be administered? (e.g. some cognitive screening tools are not recommended until several weeks of abstinence has been maintained)
  • How will screening and assessing for cognitive impairment assist the client's treatment?
  • Do clients understand why they're being asked the screening / assessment questions? Have they given consent?
  • How will the results be delivered to the client and how will they be supported?
  • Is there an implementation plan to incorporate new tools into current practices? (e.g. policy, procedures, use of or integration into client management systems, timeline, cost of implementation.)

The organisational benefits of implementing cognitive screening questionnaires or assessments include the following:

  • The results can be used to tailor treatment to a person's needs and support successful treatment outcomes.
  • Periodic screening (of some tools, e.g. MoCA) can show improvement (if any) in the person's cognitive functioning. This can be used as a tool in their treatment and to build confidence among staff that change is possible.
  • Data on the number of people accessing your service with cognitive impairment indicators can be used to support funding applications, identify areas for staff development, and support research and long-term service planning.

Find out more

For detailed information on screening and assessment of cognitive impairment, including information on training and the cost of a range of screening tools, see Screening and Assessment for Cognitive Impairment.

We Help Ourselves (WHOS) is a non-government drug and alcohol service provider in NSW engaged in an organisational change management approach which incorporated the selection and implementation of a screening and assessment tool to help identify cognitive impairment. See WHOS review of complex needs assessment and treatment options data (WHOS Complex Needs Client Data Survey: Assessment and Treatment Options).

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