Universal Risk Screening Research Articles

Practicing Best Practice: A 10‐Year Retrospective on Universal Risk Screening in a Mediation and Counseling Organization

Separation is a high‐risk time in families and for many it marks the onset or escalation of family safety and wellbeing risks like Intimate Partner Violence (IPV). Best practice for identifying such risks in court or community mediation services is systematic inquiry about safety risks with structured tools to overcome under‐reporting of risks. However, turning best practice recommendations into routine practice can take years – even when the evidence is strong that practitioners and their clients will ultimately benefit. Relationships Australia South Australia has addressed this evidence‐practice gap by engaging our leadership and undertaking whole‐of‐organization implementation of the Family DOORS framework. This includes the validated screening tool DOOR 1, that helps practitioners identify and respond to family‐wide risks during peak stress such as separation. In this article, we review our 10‐year implementation journey towards best practice in risk screening, reporting on 28,097 screens completed with clients to date. We describe the initiatives used to address practitioner and infrastructure barriers to implementation. We present both quantitative and qualitative indicators of practitioner change along with client survey data (n = 1,291), demonstrating changes in practices that have enhanced client engagement and led to an increase in client safety and wellbeing outcomes. We share recommendations for and innovations in translation to other service contexts. We hope that using the following recommendations and adopting the DOORS tools will encourage and enable others to implement best practice risk screening in far less than 10 years.

How to Use Methadone in an Era of an Opioid Epidemic

The opioid epidemic is one of the most important public health crises as opioid-related deaths have become a leading cause of accidental death in the USA. Various efforts have been made to understand how to safely and appropriately prescribe opioids for patients with chronic pain, including those with cancer-related pain. We find the guidelines proposed by the Expert Consensus White Paper on the use of methadone to be current, comprehensive, and practical. While methadone is a complex medication with unique pharmacokinetics and pharmacodynamics, it remains a superior choice for many patients with cancer pain given its cost and applicability in a variety of situations. Methadone should be prescribed in the context of experienced clinicians as well as an interdisciplinary team. At a critical time when preventing opioid-related deaths is a priority, we recommend implementing additional precautions for monitoring including universal screening for risk of non-medical opioid use, education on proper storage and disposal, as well as discussing a plan with patients and caregivers in the case of serious complications such as opioid overdose.