Screening and Selection Process
In the following paper I outline the screening process for the members of a group, Adults with a Substance Condition. First are the demographic questions and second are the screening questions. I then discuss how I will use the screening questions as selection and deselection criteria. Finally, I discuss the final step of the screening process, the one-on-one interview.
Demographic Questions
- Name:__________________________________________________________________
- Address:________________________________________________________________
- Cell Phone:______________________________________________________________
- Home Phone:_____________________________________________________________
- What is your age?_____
- What is your sex?_____
- How would you describe yourself? (Please check the option that best describes you)
- American Indian
- Pacific Islander
- Asian
- African American
- Hispanic
- Non-Hispanic White
- Are you:
- Married
- Divorced
- Separated
- Never been married
- Member of an unmarried couple
- Are you currently:
- Employed
- Self-employed
- Out of work for more than 1 year
- Out of work for less than 1 year
- A homemaker
- A student
- Retired
- Unable to work
- What is the highest grade or year of school you completed?
- Never completed high school
- High school graduate
- Some college
- Community college graduate (AA degree)
- College graduate (B.S. or B.A. degree)
- Graduate School (Advanced degree)
Screening Questions
- Are you a substance abuse addict?____________________________________________
If so, what is your drug of choice?____________________________________________
Secondary drug of choice?__________________________________________________
- Do you want to be clean and sober?___________________________________________
- Do you have any mental health conditions?_____________________________________
If so, what are they?_______________________________________________________
- Do you currently take any prescribed medications?_______________________________
If so, what are they?_______________________________________________________
- Are you suicidal?_________________________________________________________
- Are you homicidal?________________________________________________________
- Do you experience episodes of rage?__________________________________________
- Have you experienced trauma recently?________________________________________
If so, explain:____________________________________________________________
________________________________________________________________________
- Are you in the midst of an extreme crisis?______________________________________
If so, explain_____________________________________________________________
- Do you experience episodes of paranoia?_______________________________________
- Have you been to treatment for your substance condition?_________________________
If so, which treatment center?________________________________________________
How long were you in treatment?_____________________________________________
What was your discharge date?_______________________________________________
- Are you in a sober living home or are you planning on moving into a sober living home?__________________________________________________________________
If so, what is the name of the sober living home?________________________________
- Are you willing to commit to at least sixteen weeks with this counseling group?________
- Are you willing to complete homework assignments and share with the group? (i.e. relapse prevention plan)____________________________________________________
- Are you willing to confront difficult issues in your life and are you willing to learn techniques to handle the issues more effectively?________________________________
- Are you willing to support other members of the group? (i.e. listening, caring, opening up)_____________________________________________________________________