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What’s New in Screening and Assessment Tools?

Florida Partners in Crisis: Annual Conference and Justice Institute

July 13, 2011 Orlando, Florida

Roger H. Peters, Ph.D., University of South Florida, Tampa, Florida; rhp@usf.edu

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Goals of this Presentation

Review:• How to access relevant resourcesHow to access relevant resources• Challenges in selecting instrumentsChallenges in selecting instruments• Available substance abuse, mental Available substance abuse, mental

health, and related instrumentshealth, and related instruments

Resources

• CSAT TIP #42 and #44CSAT TIP #42 and #44

• CMHS National GAINS CenterCMHS National GAINS Center

• Council of State Governments Council of State Governments

• NIDANIDA

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(GAINS Center, 2004; Steadman et al., 2009)

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Co-Occurring Substance Use Disorders

74% of state prisoners with mental problems also have substance abuse or dependence problems

(U.S. Department of Justice, 2006)

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Importance of Screening and Assessment

High prevalenceHigh prevalence rates of mental and rates of mental and substance use disorders in justice settingssubstance use disorders in justice settings

Persons with undetected disorders are likely Persons with undetected disorders are likely to to cycle back throughcycle back through the justice system the justice system

Allows for Allows for treatment planningtreatment planning and linking and linking to appropriate treatment services to appropriate treatment services

Screening for MH and SA Disorders

• Routine screening for both sets of disordersRoutine screening for both sets of disorders

• Other important domains: Other important domains: trauma, motivation, trauma, motivation, criminal riskcriminal risk

• Acute MH and SA symptoms:Acute MH and SA symptoms:• Suicidal thoughts and behaviorSuicidal thoughts and behavior• Depression, hallucinations, delusionsDepression, hallucinations, delusions• Potential for drug/alcohol withdrawalPotential for drug/alcohol withdrawal• History of treatment, including use of medsHistory of treatment, including use of meds

• Determine need/urgency for referralDetermine need/urgency for referral

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Survey Results: SA Screening for Offenders

Wide variation Wide variation in types of SA in types of SA screening instruments administeredscreening instruments administered

32%32% of sites used no SA screening of sites used no SA screening instrumentsinstruments

42%42% of sites did not use a standardized of sites did not use a standardized SA screening instrumentSA screening instrument

(Taxman et al., 2007)(Taxman et al., 2007)

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Challenges in Selecting Screening Instruments

• ProliferationProliferation of screening instruments of screening instruments• Use of Use of non-standardized instrumentsnon-standardized instruments• Instruments Instruments not validated in CJ settingsnot validated in CJ settings• Absence of Absence of comparative datacomparative data• Direct to consumer marketing Direct to consumer marketing of of

instruments with poor psychometric instruments with poor psychometric properties (e.g., SASSI)properties (e.g., SASSI)

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Screening - Mental Health

• Brief Jail Mental Health ScreenBrief Jail Mental Health Screen• CODSI CODSI (Sacks et al, 2007)(Sacks et al, 2007)

• Global Appraisal of Need (GAIN - SS)Global Appraisal of Need (GAIN - SS)• Mental Health Screening Form - IIIMental Health Screening Form - III• MINI - MMINI - M

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Screening - Substance Abuse

• TCU Drug Screen – II TCU Drug Screen – II • Simple Screening Instrument Simple Screening Instrument • ASI – Alcohol and Drug Abuse sectionsASI – Alcohol and Drug Abuse sections• GAIN - SSGAIN - SS

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Specialized Screens

• BASIS-24 BASIS-24

• Centre for Addiction and Mental Health Centre for Addiction and Mental Health Concurrent Disorders Screener (CAMH-Concurrent Disorders Screener (CAMH-CDS) CDS)

• Psychiatric Diagnostic Screening Psychiatric Diagnostic Screening Questionnaire (PDSQ) Questionnaire (PDSQ)

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Instruments for Adolescents

• CAFASCAFAS• GAIN GAIN • MAYSI-2MAYSI-2• PESQPESQ• POSIT POSIT

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Other Screening Domains

• Trauma and PTSDTrauma and PTSD

• MotivationMotivation

• Criminal RiskCriminal Risk

Trauma and Victimization

• Female offenders frequently have been Female offenders frequently have been victims of physical or sexual violencevictims of physical or sexual violence

• Trauma history – should be expectation for Trauma history – should be expectation for women (and men) in justice settingswomen (and men) in justice settings

• Impact of violence is widespread, can Impact of violence is widespread, can impair recovery from MH and SA disordersimpair recovery from MH and SA disorders

Trauma and PTSD Screening Issues

• PTSD and trauma are often overlooked PTSD and trauma are often overlooked in screeningin screening

• Other diagnoses are used to explain Other diagnoses are used to explain symptomssymptoms

• Result – lack of specialized treatment, Result – lack of specialized treatment, symptoms masked, poor outcomessymptoms masked, poor outcomes

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• All offenders should be screened for All offenders should be screened for trauma historytrauma history

• Screening does not require mental health Screening does not require mental health clinician nor discussion of specific detailsclinician nor discussion of specific details

• Many public domain instruments availableMany public domain instruments available

• Positive screens - referred for assessment Positive screens - referred for assessment

Screening for Trauma and PTSD

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• Clinician-Administered PTSD Scale for Clinician-Administered PTSD Scale for DSM-IV (CAPS) DSM-IV (CAPS)

• Impact of Events Scale (IES)Impact of Events Scale (IES)• Primary Care PTSD Screen (PC-PTSD)Primary Care PTSD Screen (PC-PTSD)• PTSD Checklist – Civilian Version PTSD Checklist – Civilian Version

(PCL-C)(PCL-C)• Trauma Symptom Inventory (TSI) Trauma Symptom Inventory (TSI)

Screening Instruments for Trauma and PTSD

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Instruments – Motivation and Stages of Change

• CMRSCMRS

• RCQRCQ

• SOCRATESSOCRATES

• TCU Treatment TCU Treatment Motivation ScalesMotivation Scales

• URICAURICA

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Assessment Instruments

• Addiction Severity Index (ASI)Addiction Severity Index (ASI)

• Global Appraisal of Needs (GAIN)Global Appraisal of Needs (GAIN)

• Texas Christian University – IBRTexas Christian University – IBR- Brief Intake InterviewBrief Intake Interview- Comprehensive IntakeComprehensive Intake

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• High rates High rates of co-occurring MH/SA disordersof co-occurring MH/SA disorders

• BlendedBlended screening and assessment approach screening and assessment approach neededneeded

• Key domains: Key domains: MH, SA, trauma, criminal riskMH, SA, trauma, criminal risk• Proliferation of instrumentsProliferation of instruments, but all , but all

instruments not created equalinstruments not created equal• Many Many evidence-based instruments evidence-based instruments availableavailable

-- Most in public domainMost in public domain- - Easy to access and to administerEasy to access and to administer

Summary of Key Points