Using screening instruments

“Use screening instruments” (NBCC, 2027 task 2B.9)

Screening instruments are brief, standardized tools that flag possible problems needing further assessment. They help counselors detect depression, anxiety, trauma, substance use, suicide risk and other issues efficiently. The exam tests what screening can and cannot do and how to use common tools appropriately.

Key points

A screen identifies possible problems; it does not establish a diagnosis. A positive screen leads to a full assessment.
Common tools include the PHQ-9 (depression, scored 0 to 27, with item 9 asking about thoughts of death or self-harm), GAD-7 (anxiety, scored 0 to 21), AUDIT (alcohol), PCL-5 (PTSD symptoms) and the Columbia Suicide Severity Rating Scale screener.
Sensitivity is how well a test identifies people who have the condition; specificity is how well it identifies people who do not.
Choose tools validated for the client's age, language and population, and follow the instrument's instructions.
Respond to critical items immediately, such as a positive answer to a suicide question, rather than waiting to score the whole tool.
Repeating a screen over time can track change and inform the treatment plan.
Explain to clients why they are being screened and how results will be used.

In practice

At intake, a client's PHQ-9 total is moderate, and she answers item 9 with 'several days'. Before continuing the intake, the counselor asks directly about suicidal thoughts and completes a risk assessment.

A primary care clinic adds the GAD-7 to its intake packet. The integrated counselor follows up with patients who score in the moderate range for a fuller assessment rather than diagnosing from the score.

Check yourself

Can a positive screen alone establish a diagnosis?

No, a screen identifies possible problems that must be confirmed through a full assessment.

What does sensitivity measure in a screening tool?

The proportion of people with the condition whom the tool correctly identifies.

What should a counselor do when a client endorses PHQ-9 item 9?

Conduct a suicide risk assessment promptly, because the item concerns thoughts of death or self-harm.

NBCC's knowledge and skills for 2B. Assessment

Knowledge of: Foundational knowledge of statistics; Diagnostic criteria - DSM-5-TR; Diagnostic Criteria - ICD-11; Symptoms of trauma; Medical diagnoses and symptoms that can contribute to mental health symptoms; Differential diagnoses, co-occurring diagnoses, and comorbidities; Risk assessment and risk factors or symptoms; Cultural idioms of distress; Cultural implications of diagnosis.

Skill in: Conducting a diagnostic assessment and evaluation; Conducting and interpreting assessments; Conducting formal assessments; Conducting informal assessments; Conducting lethal means restriction.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.