Screening and Assessment of Co-Occurring Disorders in the Justice ...

… no singleclinical approachfits the needsof all thesepersons, andeffective andcomprehensivescreening andassessmentprocedures areof paramountimportancein definingthe sequence,format, andnature of neededinterventions.Inaccurate detection of co-occurring disorders in justice settings may result in:•y•yRecurrence of symptoms while in secure settingsIncreased risk for recidivism•y Missed opportunities to develop intensive treatment conditions as part ofrelease or supervision arrangements•y Failure to provide treatment or neglect of appropriate treatmentinterventions•y Overuse of psychotropic medications•y Inappropriate treatment planning and referral•y Poor treatment outcomes(Chandler et al., 2004; Drake, Alterman, & Rosenberg, 1993; Osher et al., 2003;Peters et al., in press; Teague, Schwab, & Drake, 1990).Once co-occurring disorders are identified in justice settings, the challenge is toprovide specialized treatment and transition services. Justice-involved individualswith co-occurring disorders exhibit more severe psychosocial problems, poorerinstitutional adjustment, and greater cognitive and functional deficits thanother individuals (Edens, Peters, & Hills, 1997). Comprehensive treatmentpractices involve integrating mental health and substance abuse services (Drake,Mercer‐McFadden, Mueser, McHugo, & Bond, 1998) and require coordinationbetween behavioral health and criminal justice system staff. Unfortunately,treatment providers in these two areas often have different approaches to workingwith these individuals. Finally, most jurisdictions have few resources to supportcommunity transition and follow-up treatment activities for justice-involvedindividuals with co-occurring disorders (Travis, Solomon, & Waul, 2001).Defining Screening and AssessmentIndividuals in the justice system who have co-occurring disorders are characterizedby diversity in the scope and intensity of mental health, social, medical, andother problems. As a result, no single clinical approach fits the needs of all thesepersons, and effective and comprehensive screening and assessment proceduresare of paramount importance in defining the sequence, format, and nature ofneeded interventions. Screening and assessment of co-occurring disorders are partof a larger process of gathering information that begins at the point of contactof the individual with the criminal justice system. The Center for SubstanceAbuse Treatment TIP monograph #42 (CSAT, 2005a) outlines a set of sequentialsteps that are often followed in gathering information related to co-occurringdisorders. These steps provide a blueprint for developing a comprehensive systemof screening and assessment activities, and include the following:•y Engage the offender•y Collect collateral information (e.g., from family, friends, other providers)6