SATOP Screening Questionnaire-May 2020

SATOP SCREENING QUESTIONNAIRE
Please enter your authorization code, which is a 6-digit number you received in your confirmation e-mail after you paid online. You may also have gotten your authorization code by calling our staff. If you do not have an authorization code, please contact our staff at 816-836-2220.

OOPS! YOU HAVE ENTERED AN INVALID AUTHORIZATION CODE. PLEASE CLICK THE BACK BUTTON BELOW TO GO BACK AND ENTER YOUR CODE AGAIN. (YOU WILL HAVE RECEIVED THIS CODE EITHER IN YOUR CONFIRMATION E-MAIL WHEN YOU PAID FOR THE SCREENING ONLINE, OR FROM OUR STAFF OVER THE PHONE). IF YOU DO NOT HAVE AN AUTHORIZATION CODE, YOU CANNOT COMPLETE THE SCREENING QUESTIONNAIRE AT THIS TIME - PLEASE CALL OUR STAFF AT (816)-836-2220 TO OBTAIN AN AUTHORIZATION CODE.

SATOP Screening Instructions

Thank you for choosing Midwest ADP as your provider. We endeavor to assist you in every way to help you satisfy your SATOP requirement and provide you with courteous and accurate services. Please review the information below, as these are things you need to know about the screening you are taking. If you have any questions, please do not hesitate to ask. We are here to serve you.

If you have been involved in or successfully completed treatment after your DWI referral/arrest/after being pulled over, please STOP - do not complete your test, and call our office at 816-836-2220 during our business hours of 8:30 a.m. - 5:00 p.m. and let us know ASAP. In some cases, successful completion of treatment can be a substitute for the screening.

When taking the screening, please follow these guidelines:

1.     Enter all of your demographic information. The counselor will need to input this into the screening database. We cannot complete the screening without all of the information. When asked if you've gone by a previous name, please list any maiden, married or other names you may have had a DWI court case or driving record under.

2.     On income, it is perfectly fine to estimate.

3.     When we ask, “How many times have you tried to quit drinking/drug use?” this is specifically asking if you have engaged in treatment or support groups for addictions, i.e. AA/NA meetings, counseling, faith-based treatment, etc.

4.     If you do not have your blood alcohol level, we may be able to provide that. If we do not have it, your screening cannot be completed. We will need to verify the alcohol level prior to completing the screening, however, this does not keep you from doing your screening today. If you refused to submit a sample at the time of arrest, please enter “R” on that blank. If your referral is for drugs, please enter “N.”

5.     “Total number of DWI or BAC arrests” refers to how many times you have been referred, not convicted. If it is on your driving record or in the DMH treatment database, it counts. This number has to be at least “one.”

6.     Alcohol-related (not DWI) arrests are referrals like minor in possession, open container, drunk and disorderly, etc. Please do not include DWI referrals.

7.     It is fine to estimate the number of tickets you have had in your lifetime. As this screening is called the “Drivers Risk Inventory,” twenty percent of the questions are about driving habits. These questions have absolutely no impact on your class placement. Do not be concerned if the test makes it seem that you are an aggressive or angry driver.

8.     Please do not answer “false” to all of the questions. There are seventeen questions that are, in general, designed to be answered as true. If you do not register on enough of these questions, it will impact your overall score, resulting in a higher class placement. Questions #1 and #10 are good examples of this. Simply answer the questions, don’t interpret them.

9.     For the purpose of the screening, keep alcohol and drugs as separate categories. Alcohol is not a drug for the purpose of the screening.

10. Be careful with the words “frequent, repeated, serious and significant.” Make certain that this is true about your use patterns in general. DO NOT answer the questions based upon your offense. We are asking about your use patterns in general.

11. The screening is not treatment, so you are not in treatment at this time. Also, if you have completed the first level OEP or second level WIP on a prior offense, these are not considered to be prior treatment.

12. Please note any questions that you are not comfortable or confident in answering while taking the screening. The counselor would like to review those questions prior to entering the screening in order to ensure you are being accurately represented.

Thank you for reviewing these guidelines. We look forward to serving you.

NOTE: IF WHEN YOU CLICK NEXT THIS FORM REVERTS TO THE PREVIOUS PAGE, TRY ACCESSING THE SCREENING (USING THE SAME AUTHORIZATION CODE) BY CLICKING HERE: https://form.jotform.com/201245240027137

CALL US AT 816-836-2220 IF YOU NEED ADDITIONAL HELP.

Uh oh! It looks like you've answered too many questions false...

Please review the instructions below and revise some of your answers...
Please do not answer “false” to all of the questions. There are seventeen questions that are, in general, designed to be answered as true. If you do not register on enough of these questions, it will impact your overall score, resulting in a higher class placement. Questions #1 and #10 are good examples of this. Simply answer the questions, don’t interpret them.

Thank you for completing your answer sheet...but you're not quite done yet! Next is some information about your rights as a client and form for you to complete to give us authorization to release information about you to certain parties.

Client Signature

In addition, I authorize Midwest ADP to release information about my SATOP to the following court:
(i.e., 'Independence Municipal' or 'Clay County'
In addition, I authorize Midwest ADP to release information about my SATOP to the following probation officer:
If you have a probation officer, please type his or her name
In addition, I authorize Midwest ADP to release information about my SATOP to the following attorney(s):
Attorney's Name
In addition, I authorize Midwest ADP to release information about my SATOP to the following other people or agencies:
List Name(s)
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SSN
Client Signature
Today's Date

MonthDayYear
Date
Midwest ADP is currently offering SATOP classes both using via Zoom videoconferencing as well as (limited availability) in person, and we want client feedback before making those decisions. Please indicate your preference as to in-person classes or remote classes below.
One final question! How did you find us?

Other
Please click "Submit" to submit your Questionnaire to Midwest ADP. You'll next be able to schedule a time for a quick phone call with one of our counselors to complete your SATOP screening.
Should be Empty:

Rows	True	False
1. There have been times when I have been irritated and frustrated by other drivers.
2. I am concerned about my drinking.
3. I am an impatient person and usually drive fast.
4. I have used drugs more than I should.
5. There are times when I get very angry.
6. My drinking has caused serious family and social problems for me.
7. I am quick tempered and need to learn how to control it.
8. There have been times when I have felt guilty about my use of drugs.
9. I often drink more or use more drugs than I intended.
10. There are times when I really worry about myself and my happiness.
11. There are times when I feel guilty about my drinking.
12. I can be easily annoyed and angered while driving.
13. I am concerned about my drug use.
14. I have used my cell phone while driving.
15. My drinking is more than just a little or minor problem.
16. When I get frustrated and annoyed at another driver I tend to “fly off the handle” and curse or swear at them.
17. A family member has told me I should get help for my drug use.
18. I spend a lot of time using alcohol and/or drugs and recovering from their effects.
19. There have been times when I have driven after drinking.
20. I attend Alcoholics Anonymous (AA) meetings because of my drinking.
21. Even though I wasn’t caught, I have made mistakes while driving that were my fault.
22. I have been treated for a drug problem.
23. I know I shouldn’t, but there have been times when I have been jealous of other’s success.
24. Once I begin drinking, it often seems as if I cannot stop.
25. I get angry quickly.
26. My repeated substance (alcohol/drug) use has resulted in my failing to fulfill important duties and responsibilities at home, school or work.
27. I get upset when others criticize or blame me.
28. I have had two or more memory losses (blackouts) after drinking heavily.
29. There are times when I get really frustrated and angry.
30. I admit I am often an aggressive driver.
31. I have had a drug abuse problem in the past.
32. I don’t consider myself a fast or aggressive driver, but at some point I do exceed the speed limit almost every time I drive.
33. I continue to drink despite family arguments about my drinking.
34. I regret some of the things I have said or done when I was angry or mad.
35. To be honest, I am a fast and aggressive driver.
36. There are times when I am concerned that others may think badly of me.
37. I go to Narcotics Anonymous (NA) or Cocaine Anonymous (CA) meetings because of my drug use.
38. I do not always tell the whole truth when asked about my personal life.
39. I continue my substance (alcohol/drugs) use despite the recurrent social and interpersonal problems this causes.
40. There are times when I am really down, depressed and discouraged.
41. I am a recovering alcoholic.
42. When I am angry or mad I become verbally abusive and shout or swear a lot.
43. It bothers me when I am overlooked or ignored by people I know.
44. I have given up or reduced important social, occupational or recreational activities because of my substance (alcohol/drug) use or abuse.
45. There are times when I am very unhappy.
46. I have admitted to a family member that I have a drinking problem.
47a. I have driven without proper insurance.
47b. My driver’s license has been suspended or revoked.
47c. I use my cell phone while driving.
47d. I have had three or more speeding tickets in the last ten years.
47e. I have caused two or more at-fault accidents.
48. My use of drugs has threatened my happiness and success in life.
49. Even though I am aware of the harmful effects of repeated substance use, I continue to drink and/or use non-prescription drugs.
50. Sometimes I get angry and upset at myself.
51. I have had to use much more alcohol and/or drugs to get the same effect I used to.
52. I have missed school or work because of my drinking.
53. I have lied about my use of drugs – either saying I use less than I really do, or hiding the fact that I use drugs at all.
54. I am a careless, inattentive or indifferent driver.
55. People tell me I lose control over little problems and minor frustrations.
56. I have been treated for a drinking problem.
57. I have admitted to a close family member that I have a drug problem.
58. I often take substances (alcohol/drugs) in larger amounts or over a longer period than I intended.
59. I use and sometimes abuse drugs.
60. I send and receive text messages while driving.
61. I have done things when angry or mad that I later regretted.
62. I am in counseling or treatment for my drinking problem.
63. To be honest, I drive too fast.
64. I continue to use drugs despite family arguments about my drug use.
65. Almost all of my normal daily activities are associated with (or affected by) my substance use and abuse.
66. Drinking has interfered with my happiness and success in life.
67. I have a drug problem.
68. There are times when I really worry about myself and my future.
69. Within the last year I have had persistent cravings and strong urges for my alcohol and/or drug use.
70. Because of my drug use I have given up or quit social functions, work and/or recreational activities.
71. I continue using substances (alcohol/drugs) even though I know they cause physical and psychological problems for me.
72. I have a drinking problem.
73. There have been times when I knew I should not drive – but did.

Rows	1. Rare or Never	2. Sometimes	3. Often	4. Very often or always
90. Positive Attitude / Outlook
91. Anxious / Worried / Fearful
92. Satisfied with Self / Like Self
93. Nervous / Unable to Relax
94. Impulsive / Spontaneous
95. Financially Stable / Responsible
96. Dissatisfied with Life
97. Able to Handle Life's Problems
98. Insomnia / Trouble Sleeping
99. Careful / Considerate Driver
100. Enthusiastic / Involved in Life
101. Fatigued / Tired / Sluggish
102. Angry / Hostile with Others
103. Work / Job Satisfaction
104. Tension / Stress / Pressure
105. Trust My Own Judgment
106. Depressed / Discouraged
107. Rebellious / Unruly / Defiant
108. Content with Life / Satisfied
109. Lonely / Unhappy
110. Careless / Inconsiderate Driver
111. Patient / Tolerant / Understanding
112. Emotionally Upset / Crying
113. Express My Feelings Comfortably

SATOP SCREENING QUESTIONNAIRE

Uh oh! It looks like you've answered too many questions false...