• Using a computer to conduct interviews will be a learning process for both staff members and clients. As you familiarize yourself with CARS, understand its technical directions, and incorporate it into your work with clients, it is important to remember that the efficiency of the intake process will depend on you and your client’s comfort level with the new process. In this document, we present you with a few tips focusing on the clinical aspects of interviewing using CARS. This section and the “Answering Client Questions” below should help you prepare for your interviews and anticipate difficult interview situations.
• Similar to any mental health assessment, CARS can take a considerable amount of time to complete. Just as you would with any assessment, if you think that your client is becoming anxious or tired from the length of the interview and the depth or sensitivity of the questions, it might be a good idea to consider taking a break during the assessment.
• Remember that, even with computer assistance, the assessment process is still a conversation between you and your client. You and your client should be able to converse naturally and comfortably, take breaks when necessary, and deviate from the planned interview sequence if a question (or an answer) suggests the need for additional clarification or further discussion (e.g., suicidality, abuse, anxiety, danger to others, etc). The presence of the computer should not dominate the interview situation. The computer’s role is to make the data collection easier, more efficient, and easier to aggregate.
• We encourage individuals who will be administering these interviews to do mock interviews with other administrators before interviewing clients.
• CARS will provide a report about each individual who completes the assessment. The reports from CARS or from the CARS screener will provide information about the mental health issues with which the client might be struggling and referrals for further information and treatment. These reports are a further opportunity to work with your clients. They are meant to be shared with the clients, reviewing the identified issues and discussing next steps. Clients should receive a copy of their report after discussing it.

Answering Client Questions

As you get accustomed to CARS and the changes that it will bring to your work, it is important to remember that the use of CARS will be new, maybe strange, and possibly distracting to your clients.

Some clients might express hesitation, discomfort, or resistance to participate in a computerized interview. Reasons for discomfort will vary among clients – some individuals might not understand the technology, others might suffer from paranoia or anxiety about the use of a computer, and still others might just feel that the presence of a computer is too distracting.

It’s useful to anticipate some of the questions that clients might ask so that you can react calmly to any disruptions during the assessment process.

Below we provide a table of possible questions that clients might ask when they first encounter CARS. If you can think of any other questions, or if you experience different situations when using CARS that you think would benefit other CARS users, please share them with the CARS team at info@CARStrainingcenter.org.

Q: What is this?	A: This is a computerized clinical interview. It helps us work together to identify any emotional or mental health concerns you may have.
Q: Why are you using a computer?	A: The computer helps guide our conversation. A lot of research shows that assessments are most effective when using guided interviews like this one. Note: You can show them the screen if they want to see it.
Q: How long will this take?	A: It is different for different people. [If using the CARS Screener] About 20 to 50 minutes. [If using CARS] Between 20 minutes and 2 hours. The average time is about an hour. You may take a break at any point in the interview if you need one. Note: Modules & Timing contains time estimates for the CARS Screener and for each CARS module.
Q: Who will see my answers?	A: Only staff who are associated with your case will be entitled to see your responses and know they are yours. If you would like this information shared with someone else, let us know.
Q: Who made CARS?	A: CARS was developed by a research team in Boston, the Division on Addiction. Their research focuses on addiction and other mental disorders.

Examples of Sensitive CARS Interview Questions

Below, we have included examples of sensitive questions included in the CARS modules so that you can be prepared for these questions.

Suicidal Ideation

• Have you ever seriously thought about committing suicide?
• Did you think about committing suicide?
• Did you make a suicide plan?
• Did you make a suicide attempt?
• When answering the next questions, think about the period of several days/two weeks or more (refer to two weeks if client has indicated that his or her episodes lasted this long – refer to several days if client has indicated that his or her episodes did not last 2+ weeks) during that episode when your sadness/discouragement/loss of interest and other problems were most severe and frequent. During that period, did you ever think that it would be better if you were dead?

Trauma

• Have you ever had a traumatic or scary experience, which continued to bother you or affect your life for a period of time?
• As a child, were you ever badly beaten by your parents or the people who raised you?
• The next question is about sexual assault. We define this as an event during which one person touches another person inappropriately, or without that person’s consent. Did you ever have an experience like the one I just described?

Substance Use

• During the past 6 months, how often did you inject drugs with a needle?
• Have you ever used cocaine in any form, including powder, crack, freebase, or paste?

Mental Health

• The next questions are about unusual things, like seeing visions or hearing voices. We believe that these things may be quite common, but we don’t know for sure because previous research has not done a good job asking people about them. So please take your time and think carefully before answering. The first thing is seeing a vision — that is, seeing something that other people who were there could not see. Did you ever see a vision that other people could not see?
• Please think of an episode of being sad or discouraged or uninterested lasting several days/two weeks or more (refer to two weeks if client has indicated that his or her episodes lasted this long – refer to several days if client has indicated that his or her episodes did not last 2+ weeks) when you also had the largest number of these other problems at the same time. Is there one particular episode of this sort that stands out in your mind as the worst one you ever had?
• Have you ever had a time in your life lasting several days or longer when most of the day you felt sad, empty or depressed?