Minimizing Exposure for Clinicians and Patients

The COVID-19 pandemic presents a number of challenges to people suffering from substance use disorders and the professionals who wish to treat them. How does one consider treatment that normally requires contact with other people? How do treatment providers deliver services while exercising social distancing?

There are several strategies that can minimize risks while getting people who need services into treatment programs. One strategy is to use triage and assessment techniques that can be delivered over the phone or in ways that minimize contact. This can get people started in accessing appropriate care. The other strategy is to have the testing available to determine if someone presenting for treatment has been exposed to COVID-19. Such tests should now be covered for reimbursement and should be part of a plan for widespread strategic testing.

On the first strategy, some of our online instruments at might be of assistance. Our online instruments would normally be used as computer prompted face-to-face interviews with the patient. However, several of the interviews could be used in innovative ways that minimize close contact and possible transmission. The online assessments also are compatible with telemedicine strategies.

The first assessment is the TAAD-5, a brief (10-minute) triage tool to identify whether there is evidence of a substance use disorder and whether the indicated level of severity warrants further evaluation or direct referral to treatment. With the online version of this instrument a staff person or the clinician could administer the interview over the phone to determine the action required. For example, research has shown that about 50% of first-time DUI offenders do not meet DSM-5 criteria for a SUD, but almost 10% have a serious diagnosis. The remaining individuals are in the mild to moderate range. The online system immediately generates a pdf file with the summary of findings plus item responses supporting the indications that can be reviewed by a clinician if another staff person administers the interview.

The second assessment is the CAAPE-5, which provides a detailed diagnostic assessment of substance use disorders and common co-occurring mental health conditions. The online version of the instrument can be set up as a computer-administered interview on a tablet or even a smart phone. Once a staff person enters the initial patient and demographic information a click selects self-administration. At this point the tablet can be handed to the patient to answer the questions via button and dropdown options. Upon completion of the interview, the system locks, and the tablet can be handed back to the staff person who could wipe down the tablet with a disinfectant and enter a password to unlock the system. A few observation items and comments can then be entered and the pdf file with a summary of findings and listing of all responses can be downloaded and/or printed for review.

Another advantage of online assessments is that they administration algorithms drive the interview so that the interviewer or patient simply needs to respond to the questions as they appear on the screen. This means that extensive training in the use of tools is not required and credentialed professionals can quickly verify findings and make clinical determinations.