1.2 Screening Tools and Intake

Screening Tools and Intake

Quick answer: Screening is a brief, structured process to determine whether a substance-related problem may exist and whether the person fits a program's admission criteria. The outcome is normally yes/no or risk level — not a formal diagnosis.

Screening and intake open the counselor-client relationship, but they serve different purposes. Confusing them is one of the most common CASAC exam errors. Screening answers: "Should we look deeper?" Intake answers: "Who is this person, and how does our program operate?" Assessment — covered in the next section — answers: "What is the clinical picture?"

Screening vs. Intake vs. Assessment

On the exam, read the stem's verb carefully. "Administered a 10-item questionnaire to decide whether to schedule a comprehensive evaluation" describes screening. "Collected insurance card and signed ROI forms" describes intake. "Determined moderate alcohol use disorder based on six DSM criteria" describes assessment.

Purpose of Screening

The primary purpose of screening is to determine whether a client is appropriate for and eligible for admission to a particular program — not to develop a treatment plan, establish insurance benefits (although billing may follow), or render a definitive diagnosis. Screening is intentionally short. When a screen is positive, the counselor's next clinical move is assessment, not treatment planning.

Common Screening Instruments

Counselors should know which tool matches which population and substance class:

SBIRT (Screening, Brief Intervention, and Referral to Treatment) is a public-health framework, not a single questionnaire. It combines universal screening, a brief motivational conversation for risky use, and referral to specialty treatment when indicated. Exam items may ask when SBIRT belongs in primary care versus specialty SUD settings.

Intake Essentials

Intake follows a positive screen or a direct admission request. Standard intake elements include:

• Identifying demographics and contact information
• Presenting concern and referral source
• Insurance or funding verification (logistical, not diagnostic)
• Signed consent for treatment and consent limitations (42 CFR Part 2 and HIPAA disclosures are tested more heavily in the ethics chapter, but intake is where forms are signed)
• Emergency contact and collateral permissions
• Orientation to program rules, hours, and expectations

Intake may include a brief substance-use history, but a full biopsychosocial assessment is a separate, longer process. Trap answers describe intake paperwork as if it were comprehensive assessment.

Program Eligibility and Referral Decisions

Screening also evaluates fit: a client with active unmanaged psychosis may need psychiatric stabilization before outpatient groups; someone in severe opioid withdrawal may need medically managed detox (ASAM Level 3.7 or 4) rather than standard outpatient counseling. The counselor screens for red flags and matches initial placement — detailed ASAM criteria appear in Chapter 2, but screening items expect you to recognize when referral upward is urgent.

Worked Scenario

A 19-year-old college student is referred by campus health after a DUI arrest. The counselor uses the CRAFFT questionnaire. The student scores 4, indicating a positive screen. The counselor explains next steps, completes intake forms, and schedules a biopsychosocial assessment for the following day.

Correct sequence: screen → intake → assessment (scheduled). Wrong sequence: writing treatment goals during the screen, or skipping assessment because the DUI "already proves" alcohol use disorder.

SBIRT in Brief

When an exam item describes a primary-care nurse asking three alcohol questions and providing five minutes of feedback, that is brief intervention within SBIRT — not formal counseling or treatment planning. The counselor's role in SBIRT settings is often consultation or receiving the referral after a positive screen.

Common Traps

• Choosing diagnosis when the stem describes a screening tool
• Selecting treatment planning when only eligibility has been established
• Picking DAST for an alcohol-only vignette (match tool to substance)
• Treating intake paperwork as equivalent to clinical assessment

Confidentiality at the Door

Screening and intake are where clients first hear how their information will be protected. Although 42 CFR Part 2 and HIPAA details are tested heavily in the ethics chapter, Domain 1 items may ask what you can share at intake. Rule of thumb: explain written consent requirements before contacting family, employers, or other providers. A screen result alone does not authorize broad disclosure.

Study Routine

• Build flashcards pairing each instrument (CAGE, AUDIT, DAST, CRAFFT) with population and substance.
• Write one-sentence distinctions between screening, intake, and assessment without looking at notes.
• Practice items that ask "what should the counselor do next?" after a positive screen — the best answer is almost always conduct or schedule a comprehensive assessment.
• Pair each screening tool with one setting: emergency department (AUDIT-C), adolescent clinic (CRAFFT), prenatal visit (T-ACE).