AC-OK screen for co-occurring disorders: Screening tool template & guide

Key Takeaways

The AC-OK Screen is a validated 15-question, yes/no assessment that flags co-occurring mental health, trauma, and substance use disorders in a single intake step.

It requires minimal training to administer, takes less than 10 minutes to complete, and can be scored immediately to guide clinical decisions and treatment planning.

Both adult and adolescent versions exist, and the tool shows excellent reliability (Cronbach’s Alpha ranging from 0.80 to 0.92 across subscales) and sensitivity in screening for dual diagnoses across diverse populations.

Pabau’s digital intake forms and client records help clinicians administer and document the AC-OK Screen securely within a HIPAA-compliant workflow.

Behavioral health clinicians who screen only for mental health symptoms, or only for substance use, can miss a co-occurring diagnosis. The AC-OK Screen checks for both conditions in a single intake step.

In less than 10 minutes, this validated screening tool identifies whether a patient has simultaneous mental health and substance use concerns. It’s designed for practices where every intake must be comprehensive: psychiatry practices, community mental health centers, addiction treatment programs, and integrated behavioral health practices.

This guide walks you through the AC-OK Screen’s purpose, how to administer it, how scoring works, and why digital intake forms in practice management software like Pabau make it simple to run at every intake.

What is the AC-OK Screen?

The AC-OK Screen is a brief, validated assessment tool for screening co-occurring mental health and substance use disorders in behavioral health settings. Developed by social work researcher Andrew Cherry at the University of Oklahoma (the name combines his initials, AC, with Oklahoma, OK), it has been used in behavioral health settings across the United States since the late 2000s.

Co-occurring disorders (also called dual diagnoses or comorbid conditions) mean a patient has both a diagnosable mental health condition — such as depression, anxiety, bipolar disorder, or trauma — and a substance use disorder at the same time. The AC-OK Screen detects this overlap quickly, so clinicians can structure client records and treatment plans that address both conditions.

Practices already running a full biopsychosocial assessment at intake can add the AC-OK Screen as a focused add-on rather than duplicating existing questions.

Unlike full diagnostic assessments, the AC-OK is a screening tool. It points to the need for further evaluation rather than producing a diagnosis on its own. That distinction matters for scope of practice and documentation.

In a validation study of nearly 3,000 screens, the AC-OK showed excellent reliability, very good convergent validity, and excellent sensitivity, with more modest specificity. In practice, that means it rarely misses a co-occurring case but does flag some patients who turn out not to have one. That is exactly why a positive result leads to a fuller assessment rather than a diagnosis.

How to administer the AC-OK Screen

Administering the AC-OK Screen requires minimal training, one reason it’s been widely adopted. Clinicians follow five core steps:

1. Introduce the screening at intake. Present the AC-OK as a standard part of your practice’s initial assessment. Hand the form to the patient or use digital screening forms for faster completion and automatic data capture.
2. Patient completes the self-report items. The adult form is 15 yes/no questions about the past year, grouped into mental health, trauma, and substance use. It takes about 5 to 10 minutes. Both adult and adolescent versions use age-appropriate language.
3. Clinician scores immediately after completion. Tally the yes answers in each section: questions 1 to 7 for mental health, 8 to 9 for trauma, and 10 to 15 for substance use. There are no calculations involved.
4. Interpret and document findings. A yes on both a mental health (or trauma) item and a substance use item signals a likely co-occurring disorder. Record the section totals and the clinical action you took in the patient’s record.
5. Refer or adjust treatment plan based on results. If either subscale indicates co-occurring concern, escalate to a clinician trained in dual-diagnosis treatment or update the existing treatment plan to address both domains.

Practices building a complete intake packet often pair the AC-OK with a broader adult biopsychosocial intake so mental health, substance use, and psychosocial history are captured together.

Pairing the screen with AI-powered clinical documentation like Pabau Scribe, our AI scribe, keeps the result and your next step in the patient’s record without re-keying anything by hand.

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Who is the AC-OK Screen helpful for?

The AC-OK Screen is designed for any behavioral health professional evaluating patients in settings where co-occurring disorders are common or where comprehensive intake assessment is mandated:

• Psychiatry practices integrating substance use screening into mental health intake workflows.
• Community mental health centers serving diverse populations where complex presentations are the norm.
• Substance abuse and addiction treatment programs screening for concurrent mental health disorders requiring simultaneous treatment.
• Integrated behavioral health practices offering unified mental health and substance abuse treatment under one roof.
• Trauma-informed practices assessing whether trauma presentations include substance use as a coping mechanism, often alongside a trauma timeline worksheet.
• Adolescent mental health and school-based practices using the adolescent AC-OK version to identify dual diagnoses in younger populations (ages 12-17).

The tool has been validated in English-speaking adult and adolescent populations and in international studies with Latino immigrant communities, making it applicable across diverse clinical settings.

Practices already using other behavioral health templates, such as an eating disorder worksheet or an internet addiction test, can add the AC-OK Screen to build a fuller picture of co-occurring risk factors at intake.

Benefits of using the AC-OK Screen

Early identification prevents missed diagnoses. Patients with untreated co-occurring disorders have worse outcomes. Screening from intake ensures both conditions get clinical attention and appropriate referral.

Minimal training and time burden. Clinicians do not need extensive certification to administer the AC-OK. Takes under 10 minutes, making it practical for busy intake workflows.

Validated and reliable across populations. Peer-reviewed studies confirm the AC-OK has excellent reliability, sensitivity, and specificity. It’s a psychometrically sound screener, in the same family as established tools like the PHQ-9 and GAD-7.

Supports treatment planning accuracy. Knowing upfront whether co-occurring disorders exist helps clinicians select appropriate level of care and evidence-based treatment protocols, reducing trial-and-error and improving patient outcomes.

HIPAA-compliant documentation. When administered via secure digital screening forms and encrypted client records, the AC-OK Screen supports regulatory compliance without adding manual paperwork burden, especially when paired with a standard HIPAA authorization form.

Scoring and clinical interpretation

The adult AC-OK form is 15 yes/no questions, each about the past year, split into three labeled sections: mental health (questions 1 to 7), trauma (questions 8 to 9), and substance use (questions 10 to 15). You tally the yes answers in each section.

The mental health and trauma items cover depressed mood, anxiety symptoms, racing thoughts, paranoid thinking, hallucinations, prior psychiatric medication, and trauma exposure. Any yes answers here point to a possible mental health concern.

The substance use items ask about preoccupation with alcohol use, drug use, use despite consequences, tolerance, and failed attempts to stop. A yes on these items is a positive substance use screen, which is a clinical alert requiring follow-up.

The screen works on a simple rule. When a patient answers yes on both a mental health (or trauma) item and a substance use item, that flags a likely co-occurring disorder and triggers a full assessment. Because the tool is built to catch cases rather than confirm them, it will flag some patients who turn out not to have both conditions. That is by design, and the reason a positive screen leads to assessment rather than diagnosis.

Tallying yes answers keeps automated screening workflows simple and cuts documentation time during intake.

When the mental health subscale flags a concern, many clinicians follow up with a full mental status exam before finalizing a diagnosis.

Adult vs adolescent versions and special populations

The AC-OK Screen exists in two versions: adult (18 and older) and adolescent (roughly 12 to 17). The differences are language complexity and developmental relevance. Adolescent items address peer substance use, school-based stress, and age-appropriate trauma. Adult items reflect work, family, and adult-onset conditions.

Adolescent-specific considerations: Informed consent and parental notification rules vary by jurisdiction and setting. Ensure your secure patient portal supports age-appropriate access and parental consent workflows before implementing adolescent screening, ideally alongside a dedicated adolescent intake questionnaire.

Validation in diverse populations: The AC-OK is validated in English-speaking adult and adolescent populations, and a Spanish-language version has been validated in an international sample of Latino immigrants with good to excellent psychometric properties. If your practice serves a specific population, it is still worth confirming the tool fits before relying on it exclusively.

Start screening for co-occurring disorders today

Undetected co-occurring disorders derail treatment and waste clinical resources. The AC-OK Screen offers a quick, validated, easy-to-score assessment that every intake clinician can master in minutes. Both adult and adolescent versions are ready to use, and integration with Pabau’s digital forms and client records keeps screening fast and compliant.

Download the template today and implement universal screening at your next intake appointment. See how Pabau helps behavioral health practices administer and document screening tools securely and efficiently.

Continue your research

Looking for a tool that integrates mental health and substance abuse assessment into one workflow? Mental health practice management software with integrated digital screening forms streamlines how clinicians administer validated assessment tools like the AC-OK Screen.

Need guidance on setting up compliant intake workflows? Medical forms and digital documentation best practices walk through how to design intake sequences that catch dual diagnoses without adding clinician burden.

Want to ensure your team documents co-occurring findings correctly? Psychiatric evaluation template guidance shows how to document mental health and substance use findings together in clinical notes that support treatment planning and payer documentation.

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