Transcript NIMH Co-Occurring Disorders Curriculum

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; [email protected]
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Goals of this Presentation
Review:
• How to access relevant resources
• Challenges in selecting instruments
• Available substance abuse, mental
health, and related instruments
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Resources
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CSAT TIP #42 and #44
CMHS National GAINS Center
Council of State Governments
NIDA
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(GAINS Center, 2004;
Steadman et al., 2009)
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
prevalence rates of mental and
substance use disorders in justice settings
 Persons
with undetected disorders are likely
to cycle back through the justice system
 Allows
for treatment planning and linking
to appropriate treatment services
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Screening for MH and SA Disorders
• Routine screening for both sets of disorders
• Other important domains: trauma, motivation,
criminal risk
• Acute MH and SA symptoms:
• Suicidal thoughts and behavior
• Depression, hallucinations, delusions
• Potential for drug/alcohol withdrawal
• History of treatment, including use of meds
• Determine need/urgency for referral
Survey Results: SA Screening for
Offenders
 Wide
variation in types of SA
screening instruments administered
 32% of sites used no SA screening
instruments
 42% of sites did not use a standardized
SA screening instrument
(Taxman et al., 2007)
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Challenges in Selecting
Screening Instruments
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Proliferation of screening instruments
Use of non-standardized instruments
Instruments not validated in CJ settings
Absence of comparative data
Direct to consumer marketing of
instruments with poor psychometric
properties (e.g., SASSI)
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Screening - Mental Health
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Brief Jail Mental Health Screen
CODSI (Sacks et al, 2007)
Global Appraisal of Need (GAIN - SS)
Mental Health Screening Form - III
MINI - M
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Screening - Substance Abuse
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TCU Drug Screen – II
Simple Screening Instrument
ASI – Alcohol and Drug Abuse sections
GAIN - SS
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Specialized Screens
• BASIS-24
• Centre for Addiction and Mental Health
Concurrent Disorders Screener (CAMHCDS)
• Psychiatric Diagnostic Screening
Questionnaire (PDSQ)
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Instruments for Adolescents
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CAFAS
GAIN
MAYSI-2
PESQ
POSIT
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Other Screening Domains
• Trauma and PTSD
• Motivation
• Criminal Risk
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Trauma and Victimization
• Female offenders frequently have been
victims of physical or sexual violence
• Trauma history – should be expectation for
women (and men) in justice settings
• Impact of violence is widespread, can
impair recovery from MH and SA disorders
Trauma and PTSD Screening Issues
• PTSD and trauma are often overlooked
in screening
• Other diagnoses are used to explain
symptoms
• Result – lack of specialized treatment,
symptoms masked, poor outcomes
Screening for Trauma and PTSD
• All offenders should be screened for
trauma history
• Screening does not require mental health
clinician nor discussion of specific details
• Many public domain instruments
available
• Positive screens - referred for assessment
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Screening Instruments for Trauma
and PTSD
• Clinician-Administered PTSD Scale for
DSM-IV (CAPS)
• Impact of Events Scale (IES)
• Primary Care PTSD Screen (PC-PTSD)
• PTSD Checklist – Civilian Version
(PCL-C)
• Trauma Symptom Inventory (TSI)
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Instruments – Motivation and
Stages of Change
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CMRS
RCQ
SOCRATES
TCU Treatment
Motivation Scales
• URICA
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Assessment Instruments
• Addiction Severity Index (ASI)
• Global Appraisal of Needs (GAIN)
• Texas Christian University – IBR
- Brief Intake Interview
- Comprehensive Intake
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Summary of Key Points
• High rates of co-occurring MH/SA disorders
• Blended screening and assessment approach needed
• Key domains: MH, SA, trauma, criminal risk
• Proliferation of instruments, but all
instruments not created equal
• Many evidence-based instruments available
- Most in public domain
- Easy to access and to administer
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