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

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•y•y•y•y•y•y•y•y•y•yHistory of unstable housing or homelessnessHistory of legal difficulties and/or incarcerationSuicidalityHistory of emergency room or acute care visitsHigh frequency of substance abuse relapseAntisocial or drug-using peersPoor relationships with family membersFamily history of substance use and/or mental disordersPoor adherence to treatmentHistory of disruptive behaviorObservable Signs and Symptoms of Co-Occurring DisordersIn addition to the previously listed risk factors, observable signs and symptomsof mental and substance use disorders should be reviewed during screening andassessment. These include the following:•y Unusual affect, appearance, thoughts, or speech (e.g., confusion,disorientation, rapid or slurred speech)•y Suicidal thoughts or behavior•y Paranoid ideation•y Impaired judgment and risk-taking behavior•y Drug-seeking behaviors•y Agitation, tremors, or both•y Impaired motor skills (e.g., unsteady gait)•y Dilated or constricted pupils•y Elevated or diminished vital signs•y Hyper-arousal or drowsiness•y Muscle rigidity•y Evidence of current intoxication (e.g., alcohol on breath)•y Needle track marks or injection sites•y Inflamed or eroded nasal septum•y Burns on the inside of the lipsMental Health IndicatorsMental health indicators should be examined when screening or assessing for cooccurringdisorders, including:•y Acute and observable mental health symptoms•y Suicidal thoughts and behavior11
•y•y•y•y•yAge of onset of mental health symptomsMental health treatment history (including hospitalizations), response totreatment, and use of psychotropic medicationHistory of trauma and abuseDisruptive or aggressive behaviorFamily history of mental illnessSubstance Use IndicatorsSimilarly, substance use indicators suggest the presence of co-occurring disorders:•y Evidence of acute drug or alcohol intoxication•y Signs of withdrawal from drugs or alcohol•y Signs of escalating drug or alcohol usage (e.g., from results of drug testing)•y Negative psychosocial consequences associated with substance use•y Self-reported substance abuse, including:`` Age at first use`` History of use`` Current pattern of use`` Drug(s) of choice`` Motivation for using•y Prior substance abuse treatment history, including detoxification,rehabilitation, and residential treatment•y Peers and associates who are drug users or who have antisocial features•y Family history of substance abuse•y History of overdoseCognitive and Behavioral ImpairmentScreening and assessment can be useful in detecting key cognitive and behavioralfeatures related to co-occurring disorders, which can influence the course oftreatment and may inform the type and format of treatment provided. One areathat typically does not receive sufficient attention during screening and assessmentof co-occurring disorders is cognitive and behavioral impairment related topsychosocial and interpersonal functioning. This functional impairment oftenaffects the individual’s ability to engage and effectively participate in treatment(Bellack, Bennett, & Gearon, 2007). Impairment in interpersonal or social skillsis important to assess, as this influences the ability to interact with treatmentstaff, supervision officers, and other treatment team members. Related areasof functional ability include reading and writing skills, and how the individualresponds to confrontation or stress, manages unusual thoughts and impulses, andhandles finances.12
Page 1: Screening and Assessmentof Co-Occur
Page 5 and 6: Screening Instruments for Co-Occurr
Page 12 and 13: daunting task, and often requires t
Page 14 and 15: Importance of Screening and Assessm
Page 16 and 17: •y•y•y•y•y•y•y•y•
Page 18 and 19: Developing a Comprehensive Screenin
Page 22 and 23: These areas of cognitive and behavi
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Page 26 and 27: frequency of drug testing may be ta
Page 28 and 29: offer expanded tests that also incl
Page 30 and 31: self-disclosure of mental health or
Page 32 and 33: should be determined by the severit
Page 34 and 35: Special Clinical Issues in Screenin
Page 36: suicide screening is important for
Page 39 and 40: Maintaininga staff ofdiverse ethnic
Page 41 and 42: The MHSF-III and the GAIN-SS were f
Page 43 and 44: Key Information to Include in Asses
Page 45 and 46: •y•y`` Vocational and education
Page 47 and 48: approximately two hours. Either the
Page 49 and 50: Texas Christian University Drug Scr
Page 51 and 52: & Cirimele, 2006). Hair testing can
Page 53 and 54: Appendix B: Screening Instruments f
Page 55 and 56: Suicide Probability Scale (SPS)The
Page 57 and 58: Positive Features•y•y•yThe TS
Page 59 and 60: Appendix D: Screening Instruments f
Page 61 and 62: Positive Features•y•y•y•yTh
Page 63 and 64: Positive Features•y•y•y•y
Page 65 and 66: Appendix F: Screening Instruments T
Page 67 and 68: Availability and CostThe CAMH-CDS i
Page 69 and 70: and one Axis II disorder (antisocia
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Appendix G: Screening Instruments f
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prior hospitalization for mental he
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•yThe instrument has been used wi
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•yThe instrument has not been use
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Appendix H: Screening Instruments f
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Positive Features•y•y•y•y
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have you felt you ought to Cut down
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Concerns•y•y•yThe DALI was de
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•y•y•y•y•y•y•ywith sc
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Concerns80•y•y•y•y•y•y
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Concerns•y The validity of the SS
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Appendix I: Recommended Instruments
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Concerns•y•y•y•yReliabiliti
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•y•y•y•yScales and profile
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•y•yand non-interpretable resul
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Appendix L: Assessment Instruments
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Philadelphia, PA 19106, (215) 399-0
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treatment setting. Treatment progra
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Concerns•y•y•yThe CIDI is qui
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•y•y•yThe PDSQ has been used
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Both a Research Version and a Clini
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104
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Bastiaens, L., Riccardi, K., & Sakh
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Carey, K. B., Carey, M. P., & Chand
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Demmel, R., Beck, B., Richter, D.,
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Gray, B. T. (2001). A factor analyt
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Kessler, R. C., Wittchen, H. U., Ab
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McLellan, A. T., Cacciola, J. S., &
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Nochajski, T. H., & Stasiewicz, P.
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Rollnick, H., Heather, N., Gold, R.
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Teitelbaum L. M., & Mullen, B. (200
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Zimmerman, M., & Sheeran, T. (2003)
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