SACS, Kessler and Suicide screens (SKS)

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This content will be strengthened so it more completely reflects our commitment to practice framed by te Tiriti o Waitangi, based on a mana-enhancing paradigm for practice, and drawing from ​Te Ao Māori principles of oranga to support mana tamaiti, whakapapa and whanaungatanga. We each need to consider how we can apply these principles to our practice when reading this content. The following resources provide support:
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What are the SKS screens

These three screens are tools to help practitioners to screen for substance abuse and mental health risk to te tamaiti and make decisions about further follow up. 

The screens are:

• The substances and choices scale (SACS) assesses and monitors the use and impact of alcohol and drugs.
• The Kessler screen gives an indication of psychological distress and possible mental health issues.
• The suicide screen helps to identify whether te tamaiti has active thoughts of suicide. The screen does not determine the risk level — it helps us decide whether we need a more thorough assessment.

Together these screens are known as the SKS screens.

When to use them

We use the screens together with other information to inform our assessment.

The screens must be used when:

• mental health, suicide, and/or substance use are potential concerns
• significant events, trauma, behaviours and/or risk factors are present
• tamariki are held in Police custody
• tamariki enter a residence, and at any time during the residential stay when mental health is identified as a concern or potential concern.

Policy: Assessment

When you don't need to use the SKS screens

You don't need to use the SKS screens with tamariki if:

• a recent assessment has been undertaken by a mental health or alcohol and drug service provider that details the current level of assessed risk of suicide and/or self-harm, and
• this assessment has been recorded on CYRAS, and
• there has been no significant change to the circumstances for te tamaiti since that assessment was completed.

However, you still need to consult with a Towards Wellbeing advisor and record your conversation in CYRAS.

Towards Wellbeing suicide prevention programme

Who uses them

Anyone working directly with tamariki who's been trained to use the screens.

How to use them

These screens should be introduced as part of a broader discussion about how te tamaiti is feeling and coping.

Suicide risk tool — question prompt examples

Substances and choices scale (SACS)

The SACS screen is used to identify alcohol and drug use over the last month, and its impact on te tamaiti.

Comparing SACS scores at different times can help with planning treatment and providing feedback.

Keep in mind:

• The SACS is a screening tool and should be used as a guide only — it doesn't give a diagnosis.
• A high score is a prompt to look closer at the items on the screen and have further discussions about amounts and patterns of use.
• A low score does not rule out problems — tamariki often under-estimate their drug and alcohol use, and might not answer honestly.

Substances and choices scale (SACs) screen (PDF 76 KB) 

Using and interpreting the substances and choices scale (PDF 51 KB)

Kessler screen for psychological distress 

In the last two weeks, how often did you feel:

• So sad nothing could cheer you up?
• Worried or frightened?
• Restless or stressed?
• Hopeless?
• That everything was an effort?
• Worthless?

Rating Scale:

• 0 – not at all
• 1 – a little
• 2 – some of the time
• 3 – most of the time
• 4 – all of the time

Suicide risk screen

Use the Kessler screen and these prompt questions to identify whether there is any current suicide risk and if further assessment is required:

• How do you see the future?
• Do you ever feel that life is not worth living?
• Have you ever thought you would like to end it all?

If you do suspect a risk, take immediate action — don’t assume that it’s not serious.

When suicide risk is identified