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

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should be determined by the severity of the symptoms and the general healthstatus. The utility of screening and assessment may be limited among justiceinvolvedindividuals whose symptoms are in temporary remission, so it may bemore relevant to examine the history and level of psychosocial functioning overthe past year.During the extended assessment period, addressing acute symptoms (e.g., suicidalbehavior) should take precedence over the development of a diagnosis. With someexceptions, psychotropic medication can be provided to treat acute mental healthsymptoms among individuals with co-occurring disorders who are suspected ofrecent drug or alcohol abuse. Given the variability of symptoms over time amongindividuals with co-occurring disorders, early diagnostic indicators should becontinually reexamined by staff who are knowledgeable in patterns of symptominteraction.Several steps are often taken during an extended assessment period to determinethe presence, scope, and severity of co-occurring disorders:•y Assess the significance of the substance use disorder`` Obtain a longitudinal history of mental health and substance abusesymptom onset`` Analyze whether mental health symptoms occur only in the context ofsubstance use`` Determine whether sustained abstinence leads to rapid and fullremission of mental health symptoms•y Determine the length of the current abstinence`` If four weeks of abstinence has not been achieved, diagnosis may bedelayed until this has been achieved•y Reassess mental health symptoms at the end of four weeks of abstinence•y If mental health symptoms resolve, traditional substance abuse treatmentservices may be appropriate; if not, the individual may require specializedmental health or co-occurring disorders treatment services•y Periodically reevaluate mental health symptoms and appropriateness oftreatment placementGiven thevariability ofsymptoms overtime amongindividuals withco-occurringdisorders, earlydiagnosticindicatorsshould becontinuallyreexamined bystaff who areknowledgeablein patternsof symptominteraction.Other Strategies to Enhance the Accuracy of Screening and AssessmentInformation•y•y•yUse archival records to examine the onset, course, diagnoses, and responseto treatment of mental and substance use disorders, and other relevanthistoryWait to use self-report instruments until mental health symptoms havestabilized and it is determined that an individual is not in withdrawal orintoxicatedProvide repeated screening and assessment23
•y•y•y•y•y•yProvide a supportive interview setting to promote disclosure of sensitiveclinical informationCompile self-report information in a nonjudgmental manner and in arelaxing setting. The interview should be prefaced by a clear articulation ofthe limits of confidentialityExamine non-intrusive information first (e.g., background information).After rapport has been established, proceed to address substance abuseissues, and gather mental health information last, as this information tendsto be the most stigmatizing and difficult to discloseUse motivational interviewing techniques to enhance compliance andaccurate self-reporting. Key techniques include expressing empathy,developing discrepancy between a person’s stated goals and currentbehaviors, avoiding arguing, “rolling” with resistance by offering newideas and finding ways to encourage behavior change, and supporting selfefficacyand self-confidenceUse a structured interview approach that may include: (1) screening forconsequences of substance use, (2) a lifetime history related to co-occurringdisorders, (3) a calendar method to document patterns of substance usein recent months (e.g., use of timeline follow-back procedure), and (4)assessment of current and past substance useReview the psychometric properties of available screening and assessmentinstruments. Research indicates that these instruments have differentlevels of specificity, sensitivity, and overall accuracy in justice settings, andmay also vary in their effectiveness with different ethnic and racial groups24
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 20 and 21: •y•y•y•y•y•y•y•y•
Page 22 and 23: These areas of cognitive and behavi
Page 24 and 25: •y•y•y•y•y•y•y•yAlc
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 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
Page 71 and 72: Appendix G: Screening Instruments f
Page 73 and 74: prior hospitalization for mental he
Page 75 and 76: •yThe instrument has been used wi
Page 77 and 78: •yThe instrument has not been use
Page 79 and 80: Appendix H: Screening Instruments f
Page 81 and 82: 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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