Evidence-Based Screening Instruments for Co-Occurring Disorders in the Justice System

Criminal Justice, Mental Health, and Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Substance Abuse Technical Assistance

Center – Quarterly MeetingCenter – Quarterly MeetingMarch 10, 2015March 10, 2015

Roger H. Peters, Ph.D., University of South Florida rhp@usf.edu

Lifetime Treatment History among Arrestees (ADAM II: 2007-2010; n = 18,421)

62%

27%

4% 7%

0

10

20

30

40

50

60

70

No Treatment Substance UseTreatment

Mental HealthTreatment

Substance Use &Mental Health

Treatment(Hunt, Peters, & Kremling, in press)(Hunt, Peters, & Kremling, in press)

Severity of Substance Use and Treatment History

No Treatmen

t

Mental Health

Treatment

Substance Use

Treatment

Substance Use & Mental Health

Treatment

M (SD) M (SD) M (SD) M (SD) F (df)

Drug Use Severity

2.6 (1.9) 3.1 (2.0) 3.7 (2.1) 4.2 (1.9) 318.9 (3)***

Alcohol Use

Severity

2.3 (2.0) 3.2 (2.0) 3.5 (2.1) 3.9 (2.0) 290.7 (3)***

(Hunt, Peters, & Kremling, in press) *** p < .001

Importance of Screening and Assessment for CODs

High prevalenceHigh prevalence rates of behavioral health rates of behavioral health and related disorders in justice settingsand related disorders in justice settings

Persons with undetected disorders are likely Persons with undetected disorders are likely to to cycle back throughcycle back through the justice system the justice system

Allows for Allows for treatment planningtreatment planning and linking and linking to appropriate treatment services to appropriate treatment services

Offender programs using comprehensive Offender programs using comprehensive assessment have assessment have better outcomesbetter outcomes

2015 Monograph: “Screening and Assessment of Co-Occurring Disorders in the Justice System”

Goal: Universal Screening Across Key Domains

• Mental disordersMental disorders• Substance use disordersSubstance use disorders• Trauma/PTSDTrauma/PTSD• Suicide riskSuicide risk• MotivationMotivation• Criminal riskCriminal risk

Use of Screening for Triage

• Common vocabulary Common vocabulary for court-based teamsfor court-based teams

• Avoid Avoid excluding from programs excluding from programs based on based on serious mental illnessserious mental illness

• Adaptive functioning Adaptive functioning level more important level more important for placement than diagnosesfor placement than diagnoses

• Don’t use screening in place of Don’t use screening in place of level-of-level-of-care assessment care assessment

• Identify persons needing Identify persons needing MH assessmentMH assessment

Challenges in Selecting Screening Instruments

• ProliferationProliferation of screening instruments of screening instruments• Use of Use of non-standardized instrumentsnon-standardized instruments• Instruments Instruments not validated in justice settingsnot validated in justice settings• Absence of Absence of comparative datacomparative data• Direct to consumer marketing Direct to consumer marketing of of

instruments with poor psychometric instruments with poor psychometric properties (e.g., SASSI)properties (e.g., SASSI)

How to Select Screening and Assessment Instruments

• Reliability and validity Reliability and validity of instrumentsof instruments• Ease of use Ease of use and training requirementsand training requirements• CostCost and availability and availability• Examine use and psychometric properties in Examine use and psychometric properties in

justice settingsjustice settings

• All offenders should be screened All offenders should be screened for trauma for trauma history; rates of trauma > 75% among female history; rates of trauma > 75% among female offenders and > 50% among male offendersoffenders and > 50% among male offenders

• The initial screen does not have to be conducted by The initial screen does not have to be conducted by a licensed cliniciana licensed clinician

• Many Many non-proprietary screens non-proprietary screens are availableare available

• Positive screens should be referred for Positive screens should be referred for more more comprehensive assessment comprehensive assessment

Screening for Trauma and PTSD

Trauma and PTSD Screening Issues

• PTSD and trauma are PTSD and trauma are often overlooked often overlooked in screeningin screening

• Other diagnoses Other diagnoses are used to explain are used to explain symptomssymptoms

• Result - lack of specialized treatment, Result - lack of specialized treatment, symptoms masked, symptoms masked, poor outcomespoor outcomes

Screening for Criminal Risk

• GoalsGoals: : Select offenders with Select offenders with “high risk/high need” “high risk/high need” to engage in intensive services; identify low risk to engage in intensive services; identify low risk offenders for less intensive servicesoffenders for less intensive services

• ‘‘Static’ factors Static’ factors (e.g., criminal history)(e.g., criminal history)• ‘‘Dynamic’or changeable factors - Dynamic’or changeable factors - targets of targets of

interventions in the criminal justice system interventions in the criminal justice system

Risk Screening Instruments

Monograph Reviewing Criminal Risk Instruments

Desmarais, S. L., & Singh, J. P. (2013, March). Risk assessment instruments validated and implemented in correctional settings in the United States. New York: Council of State Governments - Justice Center.  Available at: 

http://csgjusticecenter.org/wp-content/uploads/2014/07/Risk-Assessment-Instruments-Validated-and-Implemented-in-Correctional-Settings-in-the-United-States.pdf

Screening Instruments for Adolescents

• CAFASCAFAS

• GAIN GAIN

• MAYSI-2MAYSI-2

• PESQPESQ

• POSIT POSIT

Target Areas for Assessment - I

• Scope and severityScope and severity of MH and SU disorders of MH and SU disorders• Pattern of interactionPattern of interaction between the disorders between the disorders• Conditions associated with Conditions associated with occurrence and occurrence and

maintenancemaintenance of the disorders of the disorders• Antisocial attitudes, peers, personality Antisocial attitudes, peers, personality

featuresfeatures• MotivationMotivation for treatmentfor treatment• Family and social Family and social relationshipsrelationships• Physical healthPhysical health status and medical history status and medical history

Target Areas for Assessment - II

• Education and employment historyEducation and employment history• Personal Personal strengths and skillsstrengths and skills• Areas of Areas of functional impairmentfunctional impairment::

• Cognitive capacityCognitive capacity• Communication and reading skillsCommunication and reading skills• Capacity to handle stressCapacity to handle stress• Ability to participate in group Ability to participate in group

interventionsinterventions• Level of care Level of care required (e.g., ASAM)required (e.g., ASAM)

Creating Differentiated Tracks for Co-Occurring Disorders (CODs)

• Treatment TracksTreatment Tracks- Specialized residential COD treatmentSpecialized residential COD treatment- Intensive outpatient COD treatmentIntensive outpatient COD treatment- COD track within drug courtCOD track within drug court• Supervision TracksSupervision Tracks- High intensity supervision High intensity supervision (focus on dynamic risk (focus on dynamic risk

factors, frequent judicial hearings, drug testing, home factors, frequent judicial hearings, drug testing, home visits, etc.)visits, etc.)

- Medium intensity supervision Medium intensity supervision (regular monitoring, (regular monitoring, case management)case management)

• Several Several key challenges key challenges in screening and assessing in screening and assessing for co-occurring disorders in the justice systemfor co-occurring disorders in the justice system

• Screen across Screen across multiple domains multiple domains related to co-related to co-occurring disorders: occurring disorders: MH, SA, trauma/PTSD, MH, SA, trauma/PTSD, criminal riskcriminal risk

• Focus on Focus on functional impairment vs. diagnoses functional impairment vs. diagnoses in in screening for program eligibilityscreening for program eligibility

• Many Many evidence-based instruments evidence-based instruments available for:available for: - - Mental disordersMental disorders - - Substance use disordersSubstance use disorders - - Co-occurring disordersCo-occurring disorders - - Criminal riskCriminal risk

Summary of Key Points