Intake screening or initial screening procedures in rehabilitation centers are designed to determine both the person’s eligibility and readiness to be involved in treatment for an alcohol use disorder. There is no single process used by every rehabilitation facility. The intake procedures are designed to develop a personalized treatment plan for the individual based on the results of a comprehensive assessment of the person’s medical, emotional, and social functioning.
Good sources to help individuals understand the intake process include information from the Substance Abuse and Mental Health Services Administration (SAMHSA). Some of the materials that apply to the intake procedure include:
- Screening, Assessment, and Treatment Planning for Persons with Co-Occurring Disorders
- A National Review of State Alcohol and Drug Treatment Programs
- A Treatment Improvement Protocol TIP 43 (designed for withdrawal management programs for opiates, but thoroughly explains the intake process)
The intake process typically involves initial contact and a more formal and comprehensive intake evaluation at the facility once it has been decided that the person will become part of the program.
The intake process begins when the person or a family member contacts the rehabilitation center, most often by telephone or perhaps with a personal visit. The first contact is an opportunity for the rehabilitation facility to develop an effective therapeutic alliance between the members of the facility and the potential client and their family. The goals of the initial contact include:
- Crisis intervention: To identify and provide immediate assistance or intervention with emergency or crises situations that could include a person who is suicidal, who has overdosed, who is in the early stages of a moderate to severe alcohol withdrawal syndrome, who may be the victim of abuse or violence, etc.
- Determine eligibility: The initial contact is also used to ensure that the potential client satisfies any state or federal regulations regarding admission to the facility.
- Education and the development of treatment alliance: This includes a brief explanation of the program, expectations, schedules, etc.
- Identify risk factors and treatment barriers: Determine any potential situations that might interfere with the applicant’s ability to participate in treatment. This can include diagnosis of co-occurring mental health conditions or medical issues, or identifying other substances being abused. Intake personnel should also determine any special conditions that should be considered during treatment, such as cultural, ethnic, and spiritual factors that are important to the client or their family.
- Insurance eligibility/payment information: Personnel will gather information about the potential client’s insurance coverage or how the cost of treatment will be financed.
Unless there is same-day admission, an admission date should be scheduled. Depending on the needs of the client, the next step is for the client to go through an extensive and comprehensive intake process at the facility unless there is an emergency situation that requires immediate admission. In this latter case, the assessment process will be outgoing while the emergency situation is addressed. Any denial of admission should be justifiable and coincide with federal and state regulations.
During the initial stages of the admission process, the intake procedures continue. This step includes more comprehensive assessments.
- Medical and physical evaluation: Depending on the facility, there will be a comprehensive medical evaluation. This can include laboratory tests, toxicology results, a physical examination, obtaining a medical history (including alcohol use and other substance use/abuse history), obtaining any existing medical records, and perhaps a consultation with the individual’s physician. The medical examination is performed by a licensed medical professional, most often a physician, and very often includes physicians, nurses, and medical technicians. Laboratory tests can include TB tests, hepatitis tests, HIV screening, etc.
Physicians should determine the client’s potential for experiencing moderate to severe withdrawal symptoms from alcohol and then begin to develop a plan to address this. Most governmental regulatory agencies require the results of the physical examination to be in the individual’s records within 14 days of admission.
- Psychological assessment: Individuals undergo a comprehensive psychological assessment performed by a licensed mental health clinician. This can include a psychologist, social worker, or psychiatrist, and it may also include interns and other technicians. The psychological assessment will also attempt to determine any cultural, lifestyle, or as religious/spirituality factors that are unique to the person and warrant special consideration. The person’s developmental history, current level of functioning, history of substance abuse, current level of substance abuse, etc., are all documented, and further notations are made regarding potential withdrawal symptoms.
Clients are screened for common co-occurring disorders, such as major depressive disorder, anxiety disorders, and trauma- and stressor-related disorders (e.g., abuse, domestic violence, etc.), and given a general screening for other potential co-occurring disorders. In addition, clients are often required to complete extensive interviews and may even be required to complete psychometric measures that can include measures of depression, personality, substance abuse history, etc.
- Psychosocial assessment: As part of the psychological assessment and even the physical evaluation, individuals will be screened to determine any social issues that may be important to consider. There may also be a formal psychosocial assessment performed by a counselor, social worker, psychologist, etc. The psychosocial assessment will further examine the individual’s personal relationships, living situation, education, occupation, and any potential needs within these areas. As part of the psychosocial assessment the person’s living conditions may be thoroughly assessed to develop a potential discharge plan that could involve residential treatment, sober living, or a return to their normal environment. The psychosocial assessment will further elucidate any special factors that will be addressed or considered during treatment.
- Psychoeducation: As part of the intensive intake procedure, the client will be instructed on the philosophy of the rehabilitation program, the types of treatments available, their schedule, and general rules and regulations regarding visitors, meal prep, personal time, and sanctions for violating rules.
This comprehensive assessment allows the facility to develop a personalized rehabilitation plan for the individual, further document their eligibility for treatment, and identify any potential risk factors or barriers to treatment. The individual will often undergo numerous interviews. They may be required to complete numerous surveys and tests, take laboratory tests, and complete other medical procedures in order to give treatment providers as comprehensive a picture of their current level of functioning and alcohol abuse as possible. The result of the comprehensive intake process is the development of this treatment plan and a schedule of interventions that will apply to the client.
Clients are typically given a schedule of their treatments. They will be introduced to therapist and technicians as well as other clients in the facility. Once the intake process is complete and the person becomes acclimated to the program, they begin treatment. The treatment regime most often initially consists of medication (including medical detox), individual and group therapy sessions, and social support groups. Other activities may also be scheduled, such as complementary and alternative treatments.