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

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efore achieving sustained abstinence and recovery. An early form of the stages-ofchangemodel (Prochaska & DiClemente, 1992) included the following stages:•y Precontemplation (unawareness)•y Contemplation (awareness)•y Preparation (decision point)•y Action (active change behaviors)•y Maintenance (ongoing preventive behaviors)A similar stages-of-change model was developed to better understand motivationand readiness among persons with co-occurring disorders (Osher & Kofoed, 1989)and has been used to develop “stage-specific” treatment services, and to structurethe sequence of treatment approaches in some settings. This approach is premisedon the assumption that stage-specific interventions will enhance treatmentadherence and outcomes. For example, offenders in early stages of change areunlikely to respond well to treatment that does not address ambivalence andresistance related to behavior change. Similarly, offenders in later stages of changewho are placed in services that focus primarily on early recovery issues may dropout from treatment.A major underlying principle of stage-specific treatment is that assessmentof motivation and readiness should be used to match individuals to treatmentservices. The Substance Abuse Treatment Scale (SATS; McHugo, Drake, Burton,& Ackerson, 1995) is a rating scale that was developed to describe a person’s levelof engagement in treatment. This scale has been used to help match individualsto treatment and to develop appropriate services for the following “stages ofchange”:•y Pre-Engagement•y Engagement•y Early Persuasion•y Late Persuasion•y Early Active Treatment•y Late Active Treatment•y Relapse Prevention•y Remission or RecoveryA number of screening instruments have been developed for screening andassessment of motivation and readiness for treatment, and a detailed criticalreview of these instruments is provided in Appendix D.Cultural Issues Related to Screening and AssessmentGiven the large proportion of cultural and ethnic minorities in the criminaljustice system, screening and assessment approaches for co-occurring disordersshould consider influences of ethnicity, social class, gender, sexual orientation,29
Maintaininga staff ofdiverse ethnicor culturalbackgrounds ishighly importantto promotingengagementin screening,assessment, andother treatmentactivities.race, disability status, socioeconomic level, and religious and spiritual affiliation(Hienz, Preto, McGoldrick, Almeida, & Weltman, 1999). For example, havingexperienced discrimination and racism may influence the expression of mentalhealth symptoms. Individuals who have experienced shame and stigma relatedto discrimination may expect treatment staff to judge them negatively, andthis may affect treatment outcome. Experiences of poverty, discrimination, andinvolvement with the criminal justice system may also increase vulnerabilityand exposure to chronic stress (Goldstein, 1986) and shape the underlying beliefsystems of individuals regarding treatment and rehabilitation. Mental healthsymptoms may be expressed quite differently by individuals of different culturalor ethnic backgrounds and may be misinterpreted if cultural norms are notwell understood or if there is insufficient follow-up to assess the full meaningof unusual self-reported symptoms. Treatment staff should actively exploreexpectations and beliefs that may have been shaped by experiences of racism anddiscrimination, and should be cautious in determining how these affect the processof screening and assessment.Some individuals may not be fully candid during screening and assessmentinterviews because their cultural affiliation does not condone self-disclosureof problems to those outside the immediate family. Self-disclosure may also beinhibited among individuals who have experienced discrimination from peoplewho share the culture or ethnicity of the staff person conducting the screeningor assessment interview. Language barriers can also influence the outcome ofscreening and assessment interviews. Alternative strategies should be explored forindividuals who do not read or comprehend English effectively. Whenever possible,screening and assessment should be conducted in the individual’s languageof choice and by staff from a similar cultural background. Many screeninginstruments are available in Spanish or other languages, and bilingual staff canprovide assistance in conducting screening and assessment interviews. Maintaininga staff of diverse ethnic or cultural backgrounds is highly important to promotingengagement in screening, assessment, and other treatment activities.Screening Instruments for Co-OccurringDisordersWhenever feasible, standardized screening instruments should be used toidentify co-occurring disorders in the justice system. This will promote a sharedunderstanding of co-occurring problems and needed treatment interventions.Given the absence of specialized screening instruments that address the multiplerelevant components of co-occurring disorders, several instruments (e.g., mentalhealth, substance abuse, trauma/PTSD, motivation) are often combined to providea comprehensive screening. These screening instruments are sometimes includedin a battery to provide focused information regarding acute mental health andsubstance abuse needs, and suitability for placement in various settings. Screening30
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
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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 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 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
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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
Page 83 and 84: have you felt you ought to Cut down
Page 85 and 86: 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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