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

Recommended Instruments for Screening of Co-Occurring DisordersBased on comparisons of mental health screening instruments, comparisons ofsubstance abuse screening instruments, and a critical evaluation of mental health,substance abuse, and specialized co-occurring disorders screening instrumentsprovided in Appendix F, G, and H, the following combination of instruments isrecommended for screening of co-occurring disorders in justice settings:1. Either the Global Appraisal of Individual Needs (GAIN-SS) or theMental Health Screening Form-III (MHSF-III) to address mentalhealth symptoms.(and)2. Either the Simple Screening Instrument (SSI) or the Texas ChristianUniversity Drug Screen-II (TCUDS-II) to address substance abusesymptoms.This combined screening would require approximately 15–25 minutes toadminister and score. Screening for suicide risk and for trauma and abuse shouldalso be conducted. Screening for motivation and readiness for treatment may beprovided if time permits.Assessment Strategies and Instruments forCo-Occurring DisordersClinical assessment differs significantly from “classification” conducted in jailsand prisons, which involves examination of risk and other factors relevant toindividual placement, housing, work assignment, and involvement in programservices. Assessment of co-occurring disorders is usually accomplished aftercompletion of screening and referral to treatment services. If symptoms of bothmental and substance use disorders are detected during screening, the assessmentshould examine potential interactive effects of these disorders.Assessmentprovidesthe basis fordevelopment ofan individualizedtreatmentplan and acommunityreentry/followupplan forjustice-involvedindividualswho haveco-occurringdisorders.Assessment provides the basis for development of an individualized treatmentplan and a community reentry/follow-up plan for justice-involved individualswho have co-occurring disorders. Key elements of assessment of co-occurringdisorders include examination of skill deficits, the need for psychotropicmedications, and types of treatment and ancillary services needed. As notedpreviously, sufficient time should be provided prior to assessment to ensure that anindividual is detoxified and that mental health symptoms exhibited are unrelatedto withdrawal from substance use. Standardized assessment methods should beimplemented at an early stage and throughout involvement in the criminal justicesystem.33