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Agreement A-11-616-1 with UHC and VHT.pdf
12345678910111213141516171819202122232425262728AMENDMENTITOAGREEMENTTHISAMENDMENT,hereinafterreferredtoasAmendmentI,ismadeandenteredintothisdayof,2016,byandbetweenCOUNTYOFFRESNO,aPoliticalSubdivisionoftheStateofCalifornia,hereinafterreferredtoas“COUNTY”,andCONTRACTOR(S)listedinExhibitA,attachedtoCountyAgreement11-616andbythisreferenceincorporatedherein,andcollectivelyhereinafterreferredtoas“CONTRACTOR”andsuchadditionalCONTRACTOR(S)asmay,fromtimetotimeduringthetermofthisAgreement,beaddedbyCOUNTY,withtheDepartmentofBehavioralHealth(DBH)Directorordesigneeapproval.ReferencetopartyorpartiesshallbeunderstoodtorefertoCOUNTYandeachindividualCONTRACTORunlessotherwisespecified.WHEREAS,thepartiesenteredintothatcertainAgreement,identifiedasCOUNTYAgreementNo.11-616,effectiveOctober11,2011,whereby,CONTRACTOR(S)agreedtooperateaMHSAprogramtodeliverintegratedmentalhealthpreventionandearlyinterventionservicesatcommunityprimarycareclinicsasspecifiedinthisAgreementandaspartofFresnoCounty’sapprovedStatePEIPlan;andWHEREAS,COUNTYandCONTRACTORnowdesiretoamendtheAgreementregardingchangesasstatedbelowandrestatetheAgreementinitsentirety.NOW,THEREFORE,forgoodandvaluableconsideration,thereceiptandadequacyofwhichisherebyacknowledged,COUNTYandCONTRACTORagreeasfollows:1.ThattheAgreement,PageTwo(2),SectionOne(1),followingLineSeventeen(17),shallberevisedtoincludethefollowing:“G.CONTRACTOR(S)shalladministertheclinicallyappropriatestandardizedSubstanceUseDisorder(SUD)screeningtool,toidentifytheneedforSUDservices.Exhibit“I”(AUDIT),attachedheretoandincorporatedhereinbyreference,willbeusedtoscreenandidentifyadultsatriskofalcoholproblems;Exhibit“J”(DAST),attachedheretoandincorporatedhereinbyreference,willbeusedtoscreenandidentifyadultsatriskofdruguse;andExhibit“K”(CRAFFT),attachedheretoandincorporatedhereinbyreference,willbeusedtoscreenandidentifyadolescentsatriskofDrugandAlcoholuse.”I-COUNTYOFFRESNOFresno,CA 123456789101112131415161718192021222324252627282.ThisAgreementshallbeextendedforanadditionalthree(3)monthand11dayperiodbeginningJuly1,2016throughOctober11,2016.3.MaximumContractAmountFortheperiodofOctober11,2011throughOctober11,2016,innoeventshallthemaximumcontractamountfortheservicesprovidedbytheCONTRACTORtoCOUNTYunderthetermsandconditionsofthisAgreementbeinexcessofThreeMillionNineHundredThirtySevenThousandEightHundredForty-EightandNo/100Dollars($3,937,848.00).FortheperiodofOctober11,2011throughJune30,2012,innoeventshallthemaximumcontractamountfortheservicesprovidedbytheCONTRACTORtoCOUNTYunderthetermsandconditionsofthisAgreementbeinexcessofSixHundredTwenty-OneThousandOneHundredEighty-OneThousandandNo/100Dollars($621,181)duringthistwelvemonthperiod.FortheperiodofJuly1,2012throughJune30,2015,innoeventshallthemaximumcontractamountfortheservicesprovidedbytheCONTRACTORtoCOUNTYunderthetermsandconditionsofthisAgreementbeinexcessofSevenHundredSeventyTwoThousandEightHundredSixteenandNo/100Dollars($772,816)duringeachtwelvemonthperiod.FortheperiodofJuly1,2015throughJune30,2016,innoeventshallthemaximumcontractamountfortheservicesprovidedbytheCONTRACTORtoCOUNTYunderthetermsandconditionsofthisAgreementbeinexcessofSevenHundredSeventyTwoThousandEightHundredSixteenandNo/100Dollars($772,816).FortheperiodofJuly1,2016throughOctober11,2016,innoeventshallthemaximumcontractamountfortheservicesprovidedbytheCONTRACTORtoCOUNTYunderthetermsandconditionsofthisAgreementbeinexcessofTwoHundredTwentyFiveThousandFourHundredThreeandNo/100Dollars($225,403).4.COUNTYandCONTRACTORagreethatthisAmendmentIissufficienttoamendtheAgreement;andthatuponexecutionofthisAmendmentI,theAgreement,andAmendmentNo.I,togethershallbeconsideredtheAgreement.-2-COUNTYOFFRESNOFresno,CA 123456789101112131415161718192021222324252627285.TheAgreement,asherebyamended,isratifiedandcontinued.Allprovisions,terms,covenants,conditionsandpromisescontainedintheAgreementandnotamendedhereinshallremaininfullforceandeffect.ThisAmendmentIshallbecomeeffectiveuponexecutionbyallparties.COUNTYOFFRESNOFresno,CA 1 IN WI1NESS WHEREOF, the parties hereto have executed this Amendment ll to Agreement as of the 2 day and year first hereinabove written. 3 4 ATTEST: 5 CONTRACTOR(S) 6 PLEASE SEE ATTACHED SIGNATURES 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 COUNTY OF FRESNO By~~ Chairman, Board of Supervisors Date: A~ 5 . aDl(_p BERNICE E. SEIDEL, Clerk Board of Supervisors PLEASE SEE ADDITIONAL SIGNATURE PAGE ATTACHED - 4 - COUN1Y OF FRESNO Fresno,CA 12345678910111213141516171819202122232425262728APPROVEDASTOLEGALFORM:DANIELCEDERBORG,COUNTYCOUNSELA-By/(7APPROVEDASTOACCOUNTINGFORM:VICKICROW,C.P.A.,AUDITOR-CONTROLLER/TREASURER-TAXCOLLECTORBy(fa,REVIEWEDANDRECOMMENDEDFORAPPROVAL:ByDawanUtecht,DirectorDepartmentofBehavioralHealthFund/Subclass:0001/10000Organization:56304760Account/Program:7295/0FY2011-12FY2012-13FY2013-14FY2014-15FY2015-16FY2016-17$621,181(October11,2011throughJune30,2012)$772,816$772,816$772,816$772,816$225,403(July1,2016throughOctober11,2016)5COUNTYOFFRESNOFresno,CA 12345678910111213141516171819202122232425262728UNITEDHEALTHCENTERSOFTHESANJOAQUINVALLEY,INC.By:PrintName:Title:/tOChairmanofBoard,orPresidentOr,anyVicePresidentBy:PrintName:^j<3-4uu!^Title:'^(UAUoUl£>tftcefSecretaryofCorporation,'Or,anyAssistantSecretary,orChiefFinancialOfficer,orAnyAssistantTreasurerMailingAddress:650S.ZedikerAvenueBldg.3Parlier,CA93648-2639Phone:(559)646-6618Contact:ChiefExecutiveOfficer-6-COUNTYOFFRESNOFresno,CA 12345678910111213141516171819202122232425262728VALLEYHEALTHTEAM,INC.PrintName:SovlaRevna-GriffinTitle:ChiefExecutiveOfficerChairmanofBoard,orPresidentOr,anyVicePresidentBy:PrintName:Title:SecretaryofCorporation,Or,anyAssistantSecretary,orChiefFinancialOfficer,orAnyAssistantTreasurerOtyrH*Tfieyaf/zirMailingAddress:7?721890ColoradoAvenueSanJoaquin,CA93660-9712Phone:(559)693-2462Contact:ChiefExecutiveOfficer7COUNTYOFFRESNOFresno,CA Exhibit"I"TheAlcoholUseDisordersIdentificationTest(AUDIT),developedin1982bytheWorldHealthOrganization,isasimplewaytoscreenandidentifypeopleatriskofalcoholproblems.1.Howoftendoyouhaveadrinkcontainingalcohol?(0)Never(SkiptoQuestions9-10)(1)Monthlyorless(2)2to4timesamonth(3)2to3timesaweek(4)4ormoretimesaweek2.Howmanydrinkscontainingalcoholdoyouhaveonatypicaldaywhenyouaredrinking?(0)1or2(1)3or4(2)5or6(3)7,8,or9(4)10ormore3.Howoftendoyouhavesixormoredrinksononeoccasion?(0)Never(1)Lessthanmonthly(2)Monthly(3)Weekly(4)Dailyoralmostdaily4.Howoftenduringthelastyearhaveyoufoundthatyouwerenotabletostopdrinkingonceyouhadstarted?(0)Never(1)Lessthanmonthly(2)Monthly(3)Weekly(4)Dailyoralmostdaily5.Howoftenduringthelastyearhaveyoufailedtodowhatwasnormallyexpectedfromyoubecauseofdrinking?(0)Never(1)Lessthanmonthly(2)Monthly(3)Weekly(4)Dailyoralmostdaily 6.Howoftenduringthelastyearhaveyoubeenunabletorememberwhathappenedthenightbeforebecauseyouhadbeendrinking?(0)Never(1)Lessthanmonthly(2)Monthly(3)Weekly(4)Dailyoralmostdaily7.Howoftenduringthelastyearhaveyouneededanalcoholicdrinkfirstthinginthemorningtogetyourselfgoingafteranightofheavydrinking?(0)Never(1)Lessthanmonthly(2)Monthly(3)Weekly(4)Dailyoralmostdaily8.Howoftenduringthelastyearhaveyouhadafeelingofguiltorremorseafterdrinking?(0)Never(1)Lessthanmonthly(2)Monthly(3)Weekly(4)Dailyoralmostdaily9.Haveyouorsomeoneelsebeeninjuredasaresultofyourdrinking?(0)No(2)Yes,butnotinthelastyear(4)Yes,duringthelastyear10.Hasarelative,friend,doctor,oranotherhealthprofessionalexpressedconcernaboutyourdrinkingorsuggestedyoucutdown?(0)No(2)Yes,butnotinthelastyear(4)Yes,duringthelastyearAddupthepointsassociatedwithanswers.Atotalscoreof8ormoreindicatesharmfuldrinkingbehavior. Exhibit"J"NAME:DATE:DRUGUSEQUESTIONNAIRE(DAST-20)Thefollowingquestionsconcerninformationaboutyourpotentialinvolvementwithdrugsnotincludingalcoholicbeveragesduringthepast12months.Carefullyreadeachstatementanddecideifyouransweris“Yes”or“No”.Then,circletheappropriateresponsebesidethequestion.Inthestatements“drugabuse”refersto(1)theuseofprescribedoroverthecounterdrugsinexcessofthedirectionsand(2)anynon-medicaluseofdrugs.Thevariousclassesofdrugsmayinclude:cannabis(e.g.marijuana,hash),solvents,tranquillizers(e.g.Valium),barbiturates,cocaine,stimulants(e.g.speed),hallucinogens(e.g.LSD)ornarcotics(e.g.heroin).Rememberthatthequestionsdonotincludealcoholicbeverages.Pleaseanswereveryquestion.Ifyouhavedifficultywithastatement,thenchoosetheresponsethatismostlyright.©Copyright1982byHarveyA.Skinner,PhDandtheCentreforAddictionandMentalHealth,Toronto,Canada.Youmayreproducethisinstrumentfornon-commercialuse(clinical,research,trainingpurposes)aslongasyoucredittheauthorHarveyA.Skinner,DepartmentofPublicHealthSciences,UniversityofToronto. AdultVersionTheseauestionsrefertotheoast12months.CircleYourResponse1.Haveyouuseddrugsotherthanthoserequiredformedicalreasons?YesNo2.Haveyouabusedprescriptiondrugs?YesNo3.Doyouabusemorethanonedrugatatime?YesNo4.Canyougetthroughtheweekwithoutusingdrugs?YesNo5.Areyoualwaysabletostopusingdrugswhenyouwantto?YesNo6.Haveyouhad“blackouts”or“flashbacks”asaresultordruguse?YesNo7.Doyoueveryfeelbadorguiltyaboutyourdruguse?YesNo8.Doesyourspouse(orparents)evercomplainaboutyourinvolvementwithdrugs?YesNo9.Hasdrugabusecreatedproblemsbetweenyouandyourspouseoryourparents?YesNo10.Haveyoulostfriendsbecauseofyouruseofdrugs?YesNo11.Haveyouneglectedyourfamilybecauseofyouruseofdrugs?YesNo12.Haveyoubeenintroubleatwork(orschool)becauseofdrugabuse?YesNo13.Haveyoulostyourjobbecauseofdrugabuse?YesNo14.Haveyougottenintofightswhenundertheinfluenceofdrugs?YesNo15.Haveyouengagedinillegalactivitiesinordertoobtaindrugs?YesNo16.Haveyoubeenarrestedforpossessionofillegaldrugs?YesNo17.Haveyoueverexperiencedwithdrawalsymptoms(feltsick)whenyoustoppedtakingdrugs?YesNo18.Haveyouhadmedicalproblemsasaresultofyourdruguse(e.g.memoryloss,hepatitis,convulsions,bleeding,etc.)?YesNo19.Haveyougonetoanyoneforhelpfordrugproblem?YesNo20.Haveyoubeeninvolvedinatreatmentprogramspecificallyrelatedtodruguse?YesNo©Copyright1982byHarveyA.Skinner,PhDandtheCentreforAddictionandMentalHealth,Toronto,Canada.Youmayreproducethisinstrumentfornon-commercialuse(clinical,research,trainingpurposes)aslongasyoucredittheauthorHarveyA.Skinner,DepartmentofPublicHealthSciences,UniversityofToronto. AdolescentVersionThesequestionsrefertothepast12months.1.Haveyouuseddrugsotherthanthoserequiredformedicalreasons?2.Haveyouabusedprescriptiondrugs?3.Doyouabusemorethanonedrugatatime?4.Canyougetthroughtheweekwithoutusingdrugs?5.Areyoualwaysabletostopusingdrugswhenyouwantto?6.Haveyouhad“blackouts”or“flashbacks”asaresultordruguse?7.Doyoueveryfeelbadorguiltyaboutyourdruguse?8.Doyourparentsevercomplainaboutyourinvolvementwithdrugs?9.Hasdrugabusecreatedproblemsbetweenyouandyourparents?10.Haveyoulostfriendsbecauseofyouruseofdrugs?11.Haveyouneglectedyourfamilybecauseofyouruseofdrugs?12.Haveyoubeenintroubleatschoolbecauseofdrugabuse?13.Haveyoumissedschoolassignmentsbecauseofdrugabuse?14.Haveyougottenintofightswhenundertheinfluenceofdrugs?15.Haveyouengagedinillegalactivitiesinordertoobtaindrugs?16.Haveyoubeenarrestedforpossessionofillegaldrugs?17.Haveyoueverexperiencedwithdrawalsymptoms(feltsick)whenyoustoppedtakingdrugs?18.Haveyouhadmedicalproblemsasaresultofyourdruguse(e.g.memoryloss,hepatitis,convulsions,bleeding,etc.)?19.Haveyougonetoanyoneforhelpfordrugproblem?20.Haveyoubeeninvolvedinatreatmentprogramspecificallyrelatedtodruguse?CircleYourResponseYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNo©Copyright1982byHarveyA.Skinner,PhDandtheCentreforAddictionandMentalHealth,Toronto,Canada.Youmayreproducethisinstrumentfornon-commercialuse(clinical,research,trainingpurposes)aslongasyoucredittheauthorHarveyA.Skinner,DepartmentofPublicHealthSciences,UniversityofToronto. NAME:DATE:__DRUGUSEQUESTIONNAIRE(PAST-10)Thefollowingquestionsconcerninformationaboutyourpossibleinvolvementwithdrugsnotincludingalcoholicbeveragesduringthepast12months.Carefullyreadeachstatementanddecideifyouransweris“Yes”or“No”.Then,circletheappropriateresponsebesidethequestion.Inthestatements“drugabuse”refersto(1)theuseofprescribedoroverthecounterdrugsmayinclude:cannabis(e.g.marijuana,hash),solvents,tranquillizers(e.g.Valium),barbiturates,cocaine,stimulants(e.g.speed),hallucinogens(e.g.LSD)ornarcotics(e.g.heroin).Rememberthatthequestionsdonotincludealcoholicbeverages.Pleaseanswereveryquestion.Ifyouhavedifficultywithastatement,thenchoosetheresponsethatismostlyright.TheseQuestionsrefertothepast12months.CircleYourResponse1.Haveyouuseddrugsotherthanthoserequiredformedicalreasons?YesNo2.Doyouabusemorethanonedrugatatime?YesNo3.Areyoualwaysabletostopusingdrugswhenyouwantto?YesNo4.Haveyouhad"blackouts”or“flashbacks”asaresultordruguse?YesNo5.Doyoueveryfeelbadorguiltyaboutyourdruguse?YesNo6.Doesyourspouse(orparents)evercomplainaboutyourinvolvementwithdrugs?YesNo7.Haveyouneglectedyourfamilybecauseofyouruseofdrugs?YesNo8.Haveyouengagedinillegalactivitiesinordertoobtaindrugs?YesNo9.Haveyoueverexperiencedwithdrawalsymptoms(feltsick)whenyoustoppedtakingdrugs?YesNo10.Haveyouhadmedicalproblemsasaresultofyourdruguse(e.g.memoryloss,hepatitis,convulsions,bleeding,etc.)?YesNo©Copyright1982byHarveyA.Skinner,PhDandtheCentreforAddictionandMentalHealth,Toronto,Canada.Youmayreproducethisinstrumentfornon-commercialuse(clinical,research,trainingpurposes)aslongasyoucredittheauthorHarveyA.Skinner,DepartmentofPublicHealthSciences,UniversityofToronto. GUIDEFORUSINGTHEDRUGABUSESCREENINGTEST(DAST)HarveyA.Skinner,Ph.D.YorkUniversity,TorontoEmail:harvey.skinner@yorku.ca WhyassessDrugUse?Systematicassessmentofdruguseandabuseisnecessaryforensuringgoodclinicalcare.Measures,whicharebothreliableandvalid,provideinformationtothepractitioner,whichcanbeusedforidentifyingproblems(earlyifpossible)andforevaluatingtheeffectivenessoftreatment.Aswell,thisinformationisusefulformatchingpatientneedswithtailoredintervention.TheDrugAbuseScreeningTest(DAST)wasdesignedtoprovideabrief,self-reportinstrumentforpopulationscreening,clinicalcasefindingandtreatmentevaluationresearch.TheDASTyieldsaquantitativeindexofthedegreeofconsequencesrelatedtodrugabuse.Thisinstrumenttakesapproximately5minutestoadministerandmaybegivenineitheraself-reportorinterviewformat.TheDASTmaybeusedinavarietyofsettingstoprovideaquickindexofdrugabuseproblems.DAST-20andDAST-10VersionTheoriginalDASTcontained28itemsthatweremodeledafterthewidelyusedMichiganAlcoholismScreeningTest(Selzer,AmericanJournalofPsychiatry,1971,127,1653-1658).TwoshortenedversionsoftheDASTweredevisedusing20-itemsand10-itemsthatweregooddiscriminators.The20-itemDASTcorrelatedalmostperfectlyr=.99)withtheoriginal28-itemDASTismeasuringthesameconstructasthelongerscale.Moreover,theinternalconsistencyreliability(alpha)wasextremelyhigh(.95forthetotalsample,and.86forasubsamplethatexcludedclientswithonlyalcoholproblems).Gooddiscriminationisevidentamongclientsclassifiedbytheirreasonforseekingtreatment.Mostclientswithalcoholrelatedproblemsscored5orbelow,whereasthemajorityofclientswithdrugproblemsscored6oraboveonthe20-itemDAST.TheDAST-10correlatedveryhigh(r=.98)withtheDAST-20andhasexcellentinternalconsistencyreliabilityforsuchabriefscale(.92totalsampleand.74drugabuse).MeasurementpropertiesoftheDASTwereinitiallyevaluatedusingaclinicalsampleof256drug/alcoholabuseclients(Skinner...AddictiveBehaviors,1982).Theinternalconsistencyreliabilityestimatewassubstantialat.92.andafactoranalysisofitemintercorrelationssuggestedanunidimensionalscale.Withrespecttoresponsestylebiases,theDASTwasonlymoderatelycorrelatedwithsocialdesirabilityanddenial.ConcurrentvaliditywasexaminedbycorrelatingtheDASTwithbackgroundvariables,frequencyofdruguse,andpsychopathology.Agreaterrangeofproblemsassociatedwithdrugabuse(DAST)wasrelatedtothemorefrequentuseofcannabis,barbituratesandopiatesotherthenheroin.Withrespecttopsychopathology,thelargestcorrelationswerewiththesociopathicscalesofImpulseExpressionandSocialDeviation.HighscorersontheDASTtendedtoengageinrecklessactionsandexpressattitudesthataremarkedlydifferentfromcommonsocialcodes.2 Furthermore,theDASTwaspositivelyrelatedtointerpersonalproblems,suspiciousness,depressivesymptomsandapreoccupationwithbodilydysfunction.Thus,drugabusetendedtobemanifestsin,orcovarywith,otherpsychopathologicalcharacteristics.Finally,theDASTtotalscoreclearlydifferentiatedamongclientswith(1)drugproblemsonlyversus(2)mixeddrug/alcoholproblemsversus(3)alcoholproblemsonly.Advantages1.TheDASTisbriefandinexpensivetoadminister.2.Itprovidesaquantitativeindexoftheextentofproblemsrelatedtodrugabuse.Thus,onemaymovebeyondtheidentificationofadrugproblemandobtainareliableestimateofthedegreeofproblemseverity.3.DASTscorescouldbeusedtocorroborateinformationgainedbyotherassessmentsources(e.g.clinicalintervieworlaboratorytests).4.TheroutineadministrationoftheDASTwouldprovideaconvenientdeviceofrecordingtheextentofproblemsassociatedwithdrugabuse.Itwouldensurethatrelevantquestionsregardingconsequencesofdrugabuseareaskedofallclients.5.TheDASTcouldprovideareferencestandardformonitoringchangesinclientpopulationovertime,aswellasforcomparingclientsatdifferentassessmentcentres.Limitations1.SincethecontentoftheDASTitemsisobvious,clientsmayfakeresults.2.Sinceanygivenassessmentapproachprovidesanincompletepictureoftheclient’sstatus,thereisadangerthatDASTscoresmaybegiventoomuchemphasis.BecausetheDASTyieldsanumericalscore,thisscoremaybemisinterpreted.AdministrationandScoringTheDASTmaybeadministeredineitheranintervieworself-reportformat.Theself-reportversionisgenerallypreferredsinceitallowstheefficientassessmentoflargegroups.Inmanycircumstancesonewouldexpecttheinterviewandself-reportformatstogiveidenticalresults.However,theassessmentapproachesmaydiffer(1)whenaclientisparticularlydefensiveorhighonsocialanxietywhichmayproduceunder-reportingofproblemsinaface-to-faceinterviewformat,or(2)whenaclienthasdifficultyreadingandunderstandingthecontentofitemsintheself-reportversion.TheDASTshouldnotbeadministeredtoclientswhoarepresentlyundertheinfluenceofdrugs,orwhoareundergoingadrugwithdrawalreaction.Undertheseconditionsthe3 reliabilityandvalidityoftheDASTwouldbesuspect.Thus,oneshouldensurethatclientsaredrugfree(detoxifiedbeforetheDASTisadministered.Thefollowingintroductionshouldbeusedforeitherintervieworself-reportformats:‘Thefollowingquestionsconcerninformationaboutyourpotentialinvolvementwithdrugsnotincludingalcoholbeverages."“Inthestatements,‘drugabuse’refersto(1)theuseofprescribedoroverthecounterdrugsinexcessofthedirectionsand(2)anynonmedicaluseofdrugs.Thevariousclassesofdrugsmayinclude:cannabis,(e.g.marijuana,hash),solventsorglue,tranquillizers(e.g.valium),barbiturates,cocaine,stimulants,hallucinogens(e.g.LSD),ornarcotics(e.g.heroin).Rememberthatthequestionsdonotincludealcoholicbeverages.”TheDASTtotalscoreiscomputedbysummingallitemsthatareendorsedinthedirectionofincreaseddrugproblems.Twoitems:#4(Canyougetthroughtheweekwithoutusingdrugs)and#5(Areyoualwaysabletostopusingdrugswhenyouwantto),arekeyedfora“No”response.Theother18itemsarekeyedfora“Yes”response.Forexample,ifaclientcircled“Yes"foritem#1he/shewouldreceiveascoreof1,whereasiftheclientcircled“No"foritem#1he/shewouldreceiveascoreof0.Withitems#4and5,ascoreof1wouldbegivenfora“No”responseandascoreof0fora‘Yes”response.Wheneachitemhasbeenscoredinthisfashion,theDASTtotalscoreissimplythesumofthe20itemscores.Thistotalscorecanrangefrom0to20.InterpretationTheDASTtotalscoreordersindividualalongacontinuumwithrespecttotheirdegreeofproblemsorconsequencesrelatedtodrugabuse.Ascoreofzeroindicatesthatnoevidenceofdrugrelatedproblemswerereported.AstheDASTscoreincreasesthereisacorrespondingriseinthelevelofdrugproblemsreported.Themaximumscoreof20wouldindicatesubstantialproblems.Thus,astheDASTtotalscoreincreasesonemayinterpretthatagivenindividualhasaccruedanincreasinglydiverserangeofdrug-relatedconsequences.Then,onemayexaminetheDASTitemresponsestoidentifyspecificproblemareas,suchasthefamilyorwork.ThefollowingtentativeguidelinesaresuggestedforinterpretingtheDASTtotalscore.4 DASTInterpretationGuideDAST-10DAST-20ActionASAMNone00MonitorLow1-21-5BriefCounselingLevelIIntermediate(likelymeetsDSMcriteria)3-56-10Outpatient(intensive)LevelIorIISubstantial6-811-15IntensiveLevelIIor111Severe9-1016-20IntensiveLevelIIIorIVASAM:AmericanSocietyofAddictionMedicinePlacementCriteriaAlowscoredoesnotnecessarilymeanthattheclientisfreeofdrugrelatedproblems.Onemustconsiderthelengthoftimetheclienthasbeenusingdrugs,theclient’sage,levelofconsumptionandotherdatacollectedintheassessmentinordertointerprettheDASTscore.Sincemostofthealcoholabuseclientsscored5orbelow,whereasmostofthemixeddrug/alcoholclientsanddrugabusegroupscored6orabove,aDASTscoreof6orgreaterissuggestedforcasefindingpurposes.FurtherresearchisplannedtoevaluatethediagnosticvalidityofalternativecutoffpointsontheDAST.AvailabilityCopiesofthe20-itemand10-itemDASTmaybeobtainedfromtheauthor(HarveySkinner)orbycontactingMarketingServicesattheCentreforAddictionandMentalHealth,33RussellStreet,Toronto,Ontario,CanadaM5S2S1Telephone:1-800-463-6273orvisitthefollowingwebsites:HarveySkinnerat:www.HealthBehaviorChanqe.orgCAMH:www.camh.netKeyReferencesSkinner,H.A.(2001).Assessmentofsubstanceabuse:DrugAbuseScreeningTest.InR.Carson-DeWitt(Ed),EncyclopediaofDrugs,Alcohol&AddictiveBehavior.SecondEdition.Durham:NorthCarolina:MacmillanReferenceUSAp.147-148.Skinner,HA:TheDrugAbuseScreeningTest.AddictiveBehavior.1982,7,363-371.Skinner,HA;andGoldberg,A:Evidenceforadrugdependencesyndromeamongnarcoticusers.BritishJournalofAddiction.1986,81,533-538.5 Gavin,DR;Ross,HE;andSkinnerHA:DiagnosticvalidityoftheDASTintheassessmentofDSM-illdrugdisorders.BritishJournalofAddiction,1989,84,301-371.ArticlesUsingtheDASTCocco,KM;andCarey,KB(1998).PsychometricpropertiesoftheDrugAbuseScreeningTestinpsychiatricoutpatients.PsychologicalAssessment,10,408-414.Carey,MP;Carey,KB;Maisto,SA;Gleason,JR;GordonCM;andBrewer,KK(1999).HIVriskbehavioramongoutpatientsatastatepsychiatrichospital:Prevalenceandriskmodeling.BehaviorTherapy,30,389-406.Maisto,SA;Carey,MP;Carey,KB;Gleason,JG;andGordonCM(2000).UseoftheAUDITandtheDAST-10toidentifyalcoholanddrugusedisordersamongadultswithasevereandpersistentmentalillness.PsychologicalAssessment,12,186-192.Carey,MP;Carey,KB;Maisto,SA;Gordon,CM;andVanable,P(2001)PrevalenceandcorrelatesofHIV-relatedriskbehavioramongpsychiatricoutpatients.JournalofConsultingandClinicalPsychology,69,846-850.6 CAMH:HowtoorderCAMHPublicationsPage1of2JcamhTypeinwordstosearchforhereAdvancedSearch|SearchtipsClickhereforquicklinksto...SearchCentreforAddictionandMentalHaalifocentre*wxramanfc«ossantimentaeWhatistheCentreforAddictionandMentalHealthfCAMHt...?Moret.EnfranqaisAbout&tare&Treatment..';;EducationiHealthfi»t«otiofi:L:..'|-'I'fobficPdBtsw•ftesoardiNewatcamb.notAboutCAMHCAMHFoundationCareers&VolunteersPublicationsHome|Howtousethissite|Contactus|SupportCAMH:DonateonlineInPublications:MainPaoe|CAMHPublications|Currentpromotions|Crosscurrents|TheJournalofGamblingIssuesYouarehere:Home>Publications>CAMHPublications>HowtoorderCAMHPublicationsHowtoorderCAMHPublicationsOrderbyMailForyourconvenienceanorderformisincludedasaPDFfile.Pleasecompleteandmailto:MarketingandSalesServicesCentreforAddictionandMentalHealth33RussellStreetToronto,ONCanadaM5S2S1QPrintFriendlyEHfaiSlIi'"I•r•tf%CAMHRelatedLinksCAMHPublicationsCatalogue2005PDFOrderbyPhone•CustomerservicerepresentativesareavailableMondaytoFriday9a.m.-5p.m.EST®IncontinentalNorthAmericayoucanreachustoll-free:1.800.661.1111•InternationalandTorontoareacustomerscall:416.595.6059OrderbyfaxCompletetheorderformandsendto:416.593.4694CAMHPublicationsMore*Publications.OrderForm2005PDFCAMHLibraryMore>OrganizationpublicationsMore>ResearchpublicationsMore>OrderbyemailSendanemail:marketina@camh.netathttp://www.camh.net/Publications/CAMH_Press/publications_howtoorder.html12/06/2006 CAMH:DrugAbuseScreeningTest(DAST-20)Page1of1camh^«NSMr***’rw**CwveS+tatwruw*Ki-(LS-:itan4a*DrugAbuseScreeningTest(DAST-20)UpdatedApril05,200612:55PMThisfive-minutequestionnaire,usedinanintervieworself-evaluation,canhelpgaugetheseverityofaddictiontodrugsotherthanalcohol.©questionnaire»padof100®$9.95inOntario•$12.95outsideOntario®published1992•productcodePZ075©2003CentreforAddictionandMentalHealth.APAHO/WHOCollaboratingCentre.FullyaffiliatedwiththeUniversityofToronto.DISCLAIMER:Informationonthissiteisnottobeusedfordiagnosis,treatmentorreferralservicesandCAMHdoesnotprovidediagnostic,treatmentorreferralservicesthroughtheInternet.Individualsshouldcontacttheirpersonalphysician,and/ortheirlocaladdictionormentalhealthagencyforfurtherinformation.ID#P14663publishedMay23,20066:07PMhttp://www.camh.net/Publications/CAMH_Publications/drug_abuse_screening_test_pr.ht...12/06/2006 Exhibit"K"TheCRAFFTScreeningInterviewBegin:“I’mgoingtoaskyouafewquestionsthatiaskallmypatients.Pleasebehonest.Iwillkeepyouranswersconfidential.”PartADuringthePAST12MONTHS,didyou:NoYes1.Drinkanyalcohol(morethanafewsips)?>—.i—,(Donotcountsipsofalcoholtakenduringfamilyorreligiousevents.)*—1*—12.Smokeanymarijuanaorhashish?3.Useanythingelsetogethigh?dd(“anythingelse”includesillegaldrugs,overthecounterandprescriptiondrugs,andthingsthatyousniffor“huff)Forclinicuseonly:Didthepatientanswer“yes”toanyquestionsinPartA?NoYesiiAskCARquestiononly,thenstopAskall6CRAFFTquestionsPartB1.HaveyoueverriddeninaCARdrivenbysomeone(includingyourself)whowas“high”orhadbeenusingalcoholordrugs?2.DoyoueverusealcoholordrugstoRELAX,feelbetteraboutyourself,orfitin?3.Doyoueverusealcoholordrugswhileyouarebyyourself,orALONE?4.DoyoueverFORGETthingsyoudidwhileusingalcoholordrugs?5.DoyourFAMILYorFRIENDSevertellyouthatyoushouldcutdownonyourdrinkingordruguse?6.HaveyouevergottenintoTROUBLEwhileyouwereusingalcoholordrugs?NoYesddddddddddddCONFIDENTIALITYNOTICE:Theinformationrecordedonthispagemaybeprotectedbyspecialfederalconfidentialityrules(42CFRPart2),whichprohibitdisclosureofthisinformationunlessauthorizedbyspecificwrittenconsent.AgeneralauthorizationforreleaseofmedicalinformationisNOTsufficientforthispurpose.©CHILDRENSHOSPITALBOSTON,2009.ALLRIGHTSRESERVED.ReproducedwithpermissionfromtheCenterforAdolescentSubstanceAbuseResearch,CeASAR,Children’sHospitalBoston,(www.ceasar.org) SCORINGINSTRUCTIONS:FORCLINICSTAFFUSEONLYCRAFFTScoring:Each“yes”responseinPartBscores1point,Atotalscoreof2orhigherisapositivescreen,indicatinganeedforadditionalassessment.ProbabilityofSubstanceAbuse/DependenceDiagnosisBasedonCRAFFTScore,1.2X100%QIII80%i£60%T3zI40%&11Q.CB20%m0%£i1634<CRAFFTScoreDSM-IVDiagnosticCriteria3(Abbreviated)SubstanceAbuse(1ormoreofthefollowing):•Usecausesfailuretofulfillobligationsatwork,school,orhome•Recurrentuseinhazardoussituations(e.g.driving)®Recurrentlegalproblems®ContinuedusedespiterecurrentproblemsSubstanceDependence(3ormoreofthefollowing):®Tolerance•Withdrawal®Substancetakeninlargeramountoroverlongerperiodoftimethanplanned®Unsuccessfuleffortstocutdownorquit®Greatdealoftimespenttoobtainsubstanceorrecoverfromeffect®Importantactivitiesgivenupbecauseofsubstance®Continuedusedespiteharmfulconsequences©Children’sHospitalBoston,2009.Thisformmaybereproducedinitsexactformforuseinclinicalsettings,courtesyoftheCenterforAdolescentSubstanceAbuseResearch,Children’sHospitalBoston,300LongwoodAve,Boston,MA02115,U.S.A.,(617)355-5433,www.ceasar.oro.References:1.KnightJR,ShrierLA,BravenderTD,FarrellM,VanderBiltJ,ShafferHJ.Anewbriefscreenforadolescentsubstanceabuse.ArchPediatrAdolescMed1999;153(6):591-6.2.KnightJR,SherrittL,ShrierLA,HarrisSK,ChangG.ValidityoftheCRAFFTsubstanceabusescreeningtestamongadolescentclinicpatients.ArchPediatrAdolescMed2002;156(6):607-14.3.AmericanPsychiatricAssociation.DiagosticandStatisticalManualofMentalDisorders,fourthedition,textrevision.WashingtonDC,AmericanPsychiatricAssociation,2000.