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

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