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Screening Tools

Sample Screening Instruments from Screening for Substance Abuse During Pregnancy: Improving Care, Improving Health, published by the national Center for Education in Maternal and Child Health, 1997.

 

4Ps

Have you ever used drugs or alcohol during this Pregnancy?

Have you had a problem with drugs or alcohol in the Past?

Does your Partner have a problem with drugs or alcohol?

Do you consider one of your Parents to be an addict or alcoholic?

This screening device is often used as a way to begin a discussion about drug or alcohol use. Any woman who answers yes to one or more questions should be referred for further assessment.

Ewing H. Medical Director, Born Free Project. Contra Casta County, 111 Allen Street, Martinez, CA 94553. Phone: (510) 646-1165.

T-ACE

How many drinks does it take for you to feel high? (Tolerance)

Have people Annoyed you by criticizing your drinking?

Have you ever felt you ought to Cut down on your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

(Eye-opener)

Any woman who answers more than two drinks on the tolerance question is scored 2 points. Each yes to the additional three questions scores 1. A score of 2 or more is considered a positive screen, and the woman should be referred to specialist for further assessment.

Sokol RJ, Martier SS, Ager JW, 1989. The T-ACE questions: Practical prenatal detection of risk drinking. American Journal of Obstetrics and Gynecology 160(4).

 

TWEAK

How many drinks does it take for you to feel high? (Tolerance)

Does your partner (or do your parents) ever Worry or complain about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

(Eye Opener)

Have you ever Awakened the morning after some drinking the night before and found that you could not remember part of the evening before?

Have you ever felt that you ought to K/Cut down on your drinking?

A woman receives 2 points on the tolerance questions if she reports that she can hold more than 5 drinks without falling asleep or passing out. A positive response to the worry question scores 2 points, and a positive response to each of the last 3 questions scores 1 point each. A total score of 2 or more indicates that the woman is a risk drinker and requires further assessment.

Russell M. 1994. New assessment tools for risk drinking during pregnancy. Alcohol, Health and Research World 18(1).
 

Ten-Question Drinking History (TQDH)

Beer:    How many times a week do you drink beer?

            How many cans do you have at one time?

            Do you ever drink more?

Wine:   How many times per week do you drink wine?

            How many glasses do you have at one time?

            Do you ever drink more?

Liquor:  How many times per week do you drink liquor?

            How many drinks do you have at one time?

            Do you ever drink more?

            Has your drinking changed during the past year?

Any woman who reports drinking more than four drinks once a week or more is considered at risk and requires further evaluation.

Weiner L, Rosett HL, Edelin KC. 1982. Behavioral evaluation of fetal alcohol education for physicians. Alcoholism: Clinical and Experimental Research 6(2).

Alcohol and Other Drug Use

See the Microsoft Publisher document for Alcohol and Other Drug Use

Spouse Abuse Risk Assessment

From the Domestic Violence/Substance Abuse Interdisciplinary Task Force of the IL DHS (7/2000). Safety and Sobriety: Best Practices in Domestic Violence and Substance Abuse.

Name: _____________________________________________Date: ____________

Risk Factors	Low(L)	Moderate(M)	High(H)	Comments
History of Abuse	No prior reprots or injuries	Prior minor injuries	Subsequent incident or serious injury
Substance Abuse	None	Some use, non-contributing factor	Significant use, contributing factor
Extent of Physical Injury	No medical treatment needed	Minor physical injuries/ treatment	Major physical injury/ hospitalization/ injury during pregnancy
Use of Weapons	None	Weapons available, not used	Weapons used, or threat to use
Emotional Maltreatment	None/ infrequent	Frequent/ chronic	Threats of death or serious injury/ stalking
Location of Children	Known/ no risk	Known/ minimal risk	Unknown, or with perpetrator
Forced Sex	No evidence or allegation	Allegation with no evidence	Evidence of forced sex
Familiy Stressors	None	Minimal	Multiple
Location of Perpetrator	Known, no access to victim	Known, access to victim	Unknown, or at large
Assault History	None	Infrequent/ occations, episodes	Frequent/ chronic episodes
Fear of Perpetrator	None	Minimal	Significant
Safety Plan	Appropriate	Vague	None

Any "H" must be thoroughly evaluated; majority of "M's" require additional evaluation; advise the victim of the assessment and recommendations

Warning/Protection Plan
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