Frequently Asked Questions About the Substance Abuse and Vocational Rehabilitation Screener (SAVR-S)

Q: Why use the SAVR-S on all consumers?

• The SAVR-S was requested by counselors who had limited options to objectively identify possible substance abuse in their consumers.
  
• Studies have consistently shown that approximately one quarter of VR consumers have an active substance use disorder. In over 50% of these cases, the counselor may not know of this condition because the consumer did not mention it during intake and case planning.
  
• The SAVR-S is a clinical screening instrument specifically validated on VR consumers and designed to assist both the counselor and consumer in rehabilitation planning. It is accurate in identifying problems in approximately 85% of cases, which is comparable to any other substance abuse screening instrument.
  
• As stated in SAVR-S training materials, the SAVR-S is a voluntary procedure, and consumers can choose not to complete the instrument.

Q: Does the consumer need to sign an informed consent prior to completing the SAVR-S?

• Current use of the SAVR-S by VR programs is a clinical, not research activity. It does not differ from any other clinical screening that VR may use, contract for, or purchase.
  
• The state VR programs currently using the SAVR-S have agreed to conduct an evaluation of how the SAVR-S assists counselors in case planning and also whether it can positively impact successful closures. This activity is a clinical service evaluation, and it is exempted from human subjects “research”.
  
• The evaluation of this screening process using de-identified SAVR-S data has been reviewed and approved as an exempted activity by the Human Subjects Committees at Wright State and Northwestern Universities. The eventual goal of this field trial is to develop multiple administration formats that are easy for counselors to administer.

Q: What should a counselor do if the substance abuse screening reports states that the consumer has a high probability of a substance use disorder?

The counselor should:

• Review the screening results with the consumer.
  
• If the consumer reports use/abuse or the counselor suspects current use after discussing results with the consumer, request an additional assessment           
  

Q: What should a counselor do if a consumer tests positive on a drug test? Is it sufficient to use an alcohol and drug assessment or should a full scale psychological evaluation be requested?

• Unless there is specific evidence of co-occurring mental illness, there is no need for a full psychological evaluation. When requesting a chemical dependency assessment from a licensed provider, the counselor should ask if any further assessments are recommended. Any recommendations should be included in the written report to the counselor.
  
• The counselor should arrange an immediate meeting with the consumer to discuss the implications to employment.
  
• If an SUD assessment has not been conducted, arrange for one to take place.
  
• The counselor should determine if SUD issues are being adequately addressed in the IPE and amend it as needed.
  
• Interrupt services as appropriate to ensure adherence to responsibilities and/or initiate intervention services.
  
• The same steps should be followed if a consumer tests positive on random drug screen, resulting in the loss of employment.
  

Q: Does the consumer need to sign an informed consent prior to completing the SAVR-S?

• Current use of the SAVR-S by VR programs is a clinical, not research activity. It does not differ from any other clinical screening that VR may use, contract for, or purchase.
  
• The state VR programs currently using the SAVR-S have agreed to conduct an evaluation of how the SAVR-S assists counselors in case planning and also whether it can positively impact successful closures. This activity is a clinical service evaluation, and it is exempted from human subjects “research”.
  
• The evaluation of this screening process using de-identified SAVR-S data has been reviewed and approved as an exempted activity by the Human Subjects Committees at Wright State and Northwestern Universities. The eventual goal of this field trial is to develop multiple administration formats that are easy for counselors to administer.

Q: What should a counselor do if the SAVR-S report states that the consumer has a high probability of a substance use disorder?

• Present the SAVR-S results up front and without bias. Allows the consumer the opportunity to affirm, reject, or question the meaning of the results, and discuss what the results might mean in the VR process.
• Remind the consumer that the SAVR-S does not constitute a diagnosis-it is only a tool to detect the possibility of SUD, and NO screener is 100% accurate. A positive SAVR-S report simply means that there may be a need to seek out assessment services.

• If a consumer is concerned that the SAVR-S is inaccurately reporting a positive result, the counselor may present the option of additional assessment as a way for the consumer to further justify her/his denial of a problem. Conversely, if the consumer does not argue the SAVR-S report, working with the consumer to schedule a formal AOD assessment with a qualified provider can be a powerful tool to gaining additional insight into the person’s issues.

Q: What further diagnostics should be done after a screening for substance abuse (either paper/pencil or urine test) is positive? Is it sufficient to use an alcohol and drug assessment or should a full scale psychological be used?

• There is no need for a full psychological unless there is specific evidence of co-occurring mental illness.

• Most SUD treatment programs include mental health functioning assessment due to the growing awareness of the co-existing nature of mental health and SUD problems. Many states now have special designations for their SUD treatment programs if they serve this type of "dual diagnosis".

• If the above statement is not true for your geographic location or treatment setting, the decision will fall to the VR counselor (and supervisor if requested) and consumer. After all, the VR counselor remains best rehabilitation tool available!

Q: What should a counselor do if the consumer refuses to participate in a drug assessment or drug screen?

• Maintain perspective on the refusal. Why is the consumer refusing? Are they fearful? Do they lack information about what the screen or assessment represents? What does the consumer fear will happen if she/he participates?

• Do not downplay or disrespect the consumer’s concerns or choice to refuse. Explain the testing process to the consumer, addressing the rationale behind the refusal.

• If the consumer still refuses, let the consumer know that their decision will be respected. However, the lack of this information may create additional challenges to developing the most effective and efficient VR plan. This should not be presented as a threat or manipulation, but as an informed sharing of information.

• Let the consumer know that there may be future opportunity to revisit screening and/or assessment.

Q: What should a counselor do if a consumer tests positive in a drug screen such as a urine test?

• Schedule an immediate meeting with the consumer and discuss the consequences of this positive test and behavior. Explain your agency’s rules concerning this result as it pertains to services.

• Explain that positive drug tests result in inability to obtain, or retain, employment, and such a result is incompatible with employment. As such, it is a critical issue in the provision of VR services.

• Adjust the consumer’s VR plan to address the behavior, using input from the consumer. This plan may include substance abuse assessment, consultation with a substance abuse specialist, substance abuse or mental health treatment, attendance at self-help support groups (e.g., AA), planning for future random drug tests, and the creation of a “recovery plan”.

Q: Is failing one drug test enough reason to close a case?

• Relapse is an integral component of recovery for most persons with a substance use disorder, as consumers attempt various strategies to cope with their dependency.

• A relapse can be an important time for learning from the experience to strengthen the recovery plan. An immediate meeting with the consumer is important, at which time a clear direction for sustaining and strengthening recovery should be addressed, following your agency’s specific guidelines.

Q: Why should VR counselors use the SAVR-S as part of a consumer’s plan for successful employment?

• It has been estimated that over 20% of VR applicants have an active or recent substance abuse problem. These include people with other disabilities such as traumatic brain injury, spinal cord injury, diabetes, and mental illness, to name a few.
• Substance abuse is an equal opportunity disorder – anyone might have a problem.
• Substance abuse is a significant barrier to success in obtaining employment and self-sufficiency. Identification of these barriers is part of the job for rehabilitation counselors.

Q: When should consumers participate in SAVR-S screening?

• Consumers should (ideally) participate in taking the SAVR-S during the early stages of their VR participation. Therefore, it should be presented to the consumer during the initial stages of the standard data-gathering process.

• Completing the SAVR-S early allows you access to relevant SUD information during the early stages of IPE development, when such considerations should be processed.

• Bringing the SAVR-S into the VR process early provides a vehicle for discussing positive or negative findings in relation to how the consumer’s use may impact their disability, employment, or other aspects of life.

• The SAVR-S is an integral part of a holistic survey designed to provide the most appropriate and effective VR services possible.

Q: What should a counselor do if he/she suspects that the consumer has SUD issues and the consumer denies it?

• It is important that the counselor have an objective rationale that can be discussed with the consumer. This is where the SAVR-S is particularly useful, especially compared to subjective “hunches” that are not supported by evidence.

• Denial may represent a consumer/counselor dynamic that needs to be addressed. For example, a consumer who denies alcohol or drug problems despite evidence to the contrary may be exhibiting denial as a symptom of problem use.

• Subsequent interaction with the consumer, as well as their compliance with scheduled appointments and rehabilitation recommendations can serve to verify counselor suspicions.

• In addition, a consumer with an abuse or dependence problem
  • may not want to admit that they have a problem;
  • may recognize their problem internally, but may not feel comfortable allowing others to see this problem and worry about stigma;
  • may not fully understand how their substance use may impact their life, and may need to gain additional education to grasp this perspective;
  • may fear that being honest about their use may create additional problems that they prefer to avoid.
• Whatever the root cause of the denial, the counselor must understand that denial is a basic human defense mechanism that people may rely on in their daily lives. Denial in itself does not indicate a substance abuse problem.

• Direct confrontation should not be the primary focus; instead, listen closely to the consumer so that she/he feels more comfortable in sharing.

• When discrepancies in the consumer’s story arise, gently, yet consistently present the discrepancy back to the consumer. This approach will demonstrate respect, trust, and investment in the relationship.

Q: Can I require a period of abstinence for someone with SUD?

• Requiring a period of abstinence prior to the provision of VR services is not consistent with the Rehabilitation Act Amendments, and is not therapeutic for the consumer in many cases.
• It is best to negotiate a recovery plan with the consumer that is appropriate for that person, and mutually agree upon steps to sustain that recovery.
• Above all, the consumer needs to understand the critical importance of recovery as an underpinning for sustained employment.

Q: When does a counselor have grounds to deny services because of substance abuse issues?

• This issue may be specifically addressed by your agency: you should consult with your supervisor concerning your specific regulations.

• If a consumer is unwilling to discuss or consider specific steps to address substance abuse recovery as a component of their employment plan, then the probabilities for success are not good.

• In some instances, VR resources are wasted when assisting the individual with employment until the consumer is willing to address these behaviors.

Q: What recourse do I have if my consumer will not agree to random drug testing as part of the IPE and I suspect continuing drug use?

• There are two distinct lines of thought on drug testing as a component of rehabilitation programs. Some programs and professionals feel that drug testing is an important “reality test” of how well the consumer if progressing. Others feel that recovery is only under the control of the consumer any way, and they will learn from negative experiences with or without this requirement.
• Required drug testing may “artificially” enforce abstinence, and the consumer may still relapse as soon as the requirement is lifted.
• The counselor may be able to detect on-going substance abuse, with or without drug testing, because of other behaviors Ultimately, the more important issues are whether the consumer is willing to address substance abuse in a meaningful and effective way, and whether the consumer continues to demonstrate gains in their recovery.
• Alternatives to drug testing as a component of the recovery plan can include attending substance abuse treatment or aftercare, attending self-help support meetings, or periodic meetings with a counselor or case manager versed in substance abuse recovery.

It also is possible to create a written contract with the consumer, so that if additional problem behaviors are encountered then the consumer agrees to a specific course of action.

To register in order to receive a copy of the SAVR-S with our counselor number printed on it and to receive SAVR-S reports, go to
http://www.savr-s.com/Register.aspx

To receive up to eight free CEUs regarding information on the SAVR-S and substance abuse issues in VR, go to
www.myvrtraining.com