1 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;

2 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 health, and related instrumentsAvailable substance abuse, mental health, and related instruments

Resources CSAT TIP #42 and #44CSAT TIP #42 and #44 CMHS National GAINS CenterCMHS National GAINS Center Council of State GovernmentsCouncil of State Governments NIDANIDA 3

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

5 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)

6 Importance of Screening and Assessment High prevalence rates of mental and substance use disorders in justice settings High prevalence rates of mental and substance use disorders in justice settings Persons with undetected disorders are likely to cycle back through the justice system Persons with undetected disorders are likely to cycle back through the justice system Allows for treatment planning and linking to appropriate treatment services Allows for treatment planning and linking 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: trauma, motivation, criminal riskOther important domains: trauma, motivation, criminal 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

8 Survey Results: SA Screening for Offenders Wide variation in types of SA screening instruments administered Wide variation in types of SA screening instruments administered 32% of sites used no SA screening instruments 32% of sites used no SA screening instruments 42% of sites did not use a standardized SA screening instrument 42% of sites did not use a standardized SA screening instrument (Taxman et al., 2007)

9 Challenges in Selecting Screening Instruments Proliferation of screening instrumentsProliferation of screening instruments Use of non-standardized instrumentsUse of non-standardized instruments Instruments not validated in CJ settingsInstruments not validated in CJ settings Absence of comparative dataAbsence of comparative data Direct to consumer marketing of instruments with poor psychometric properties (e.g., SASSI)Direct to consumer marketing of instruments with poor psychometric properties (e.g., SASSI)

10 Screening - Mental Health Brief Jail Mental Health ScreenBrief Jail Mental Health Screen CODSI (Sacks et al, 2007)CODSI (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

11 Screening - Substance Abuse TCU Drug Screen – IITCU Drug Screen – II Simple Screening InstrumentSimple Screening Instrument ASI – Alcohol and Drug Abuse sectionsASI – Alcohol and Drug Abuse sections GAIN - SSGAIN - SS

12 Specialized Screens BASIS-24BASIS-24 Centre for Addiction and Mental Health Concurrent Disorders Screener (CAMH- CDS)Centre for Addiction and Mental Health Concurrent Disorders Screener (CAMH- CDS) Psychiatric Diagnostic Screening Questionnaire (PDSQ)Psychiatric Diagnostic Screening Questionnaire (PDSQ)

13 Instruments for Adolescents CAFASCAFAS GAINGAIN MAYSI-2MAYSI-2 PESQPESQ POSITPOSIT

14 Other Screening Domains Trauma and PTSDTrauma and PTSD MotivationMotivation Criminal RiskCriminal Risk

Trauma and Victimization Female offenders frequently have been victims of physical or sexual violenceFemale offenders frequently have been victims of physical or sexual violence Trauma history – should be expectation for women (and men) in justice settingsTrauma history – should be expectation for women (and men) in justice settings Impact of violence is widespread, can impair recovery from MH and SA disordersImpact of violence is widespread, can impair recovery from MH and SA disorders

Trauma and PTSD Screening Issues PTSD and trauma are often overlooked in screeningPTSD and trauma are often overlooked in screening Other diagnoses are used to explain symptomsOther diagnoses are used to explain symptoms Result – lack of specialized treatment, symptoms masked, poor outcomesResult – lack of specialized treatment, symptoms masked, poor outcomes

17 All offenders should be screened for trauma historyAll offenders should be screened for trauma history Screening does not require mental health clinician nor discussion of specific detailsScreening does not require mental health clinician nor discussion of specific details Many public domain instruments availableMany public domain instruments available Positive screens - referred for assessmentPositive screens - referred for assessment Screening for Trauma and PTSD

18 Clinician-Administered PTSD Scale for DSM-IV (CAPS)Clinician-Administered PTSD Scale for 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 (PCL-C)PTSD Checklist – Civilian Version (PCL-C) Trauma Symptom Inventory (TSI)Trauma Symptom Inventory (TSI) Screening Instruments for Trauma and PTSD

19 Instruments – Motivation and Stages of Change CMRSCMRS RCQRCQ SOCRATESSOCRATES TCU Treatment Motivation ScalesTCU Treatment Motivation Scales URICAURICA

20 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 Interview -Comprehensive Intake

21 High rates of co-occurring MH/SA disordersHigh rates of co-occurring MH/SA disorders Blended screening and assessment approach neededBlended screening and assessment approach needed Key domains: MH, SA, trauma, criminal riskKey domains: MH, SA, trauma, criminal risk Proliferation of instruments, but all instruments not created equalProliferation of instruments, but all instruments not created equal Many evidence-based instruments availableMany evidence-based instruments available -Most in public domain - Easy to access and to administer Summary of Key Points