Co-Occurring Disorders in Criminal Justice Settings
Integrated Assessment in Criminal Justice Settings
The assessment process for co-occurring disorders involves information gathering through a clinical examination of the individual, contact with friends and family members, and coordination with behavioral health providers and other criminal justice agencies. Information provided by friends, family, and agencies is important for developing a full understanding of the individual.
Assessment of co-occurring disorders follows screening. It is not limited to diagnosis.
The goals of assessment are to determine the following:
- History, presence, interaction, and severity of mental and substance use disorders, including a formal diagnosis.
- Related or complicating health conditions (e.g., diabetes, traumatic brain injury).
- Treatment history and current connection with behavioral health services.
- Functional impairment and cognitive deficits.
- Level of care.
- Likelihood of engagement and responsiveness to treatment.
- Risk of continued criminal or antisocial behavior, violence to self or others.
- History of traumatic experiences (e.g., physical abuse by a friend or family member).
- Personal strengths and cultural/environmental needs and supports.
- Treatment recommendations.
Assessment informs treatment
The purpose of assessment is to develop a view of the individual—his or her strengths and weaknesses, supports, and needs—to inform treatment planning and delivery. This process involves gathering non-clinical information, such as background information on:
- Employment status
- Cultural factors
- Presence of positive supports
- Housing stability
- Relationship to dependent children.
Also, the assessment may examine mental health symptoms before and during periods of substance use and abstinence.
The Center for Substance Abuse Treatment (2005) has developed guidelines for conducting an assessment of co-occurring disorders in 12 steps. These can be found in Treatment Improvement Protocol Series 42, Substance Abuse Treatment for Persons With Co-occurring Disorders.
Friends, family members, and records from behavioral health and criminal justice agencies are important supplements to the clinical examination. They are sometimes called "collateral sources." Assuming the individual allows information to be released, collateral sources help fill in the gaps in a person's memory associated with co-occurring disorders. Records from behavioral health and criminal justice agencies are valuable for ensuring continuity of care (especially for medications) and developing linkages as part of transition planning.
Time and symptom interaction may complicate assessment.
Two factors complicate the assessment of co-occurring disorders in criminal justice settings: time and symptom interaction.
- Time. The amount of time an individual is supervised by a criminal justice agency varies from a day or two to many years. Jails often handle individuals for only a few days before releasing them back to the community. A jail may have to roll assessment and treatment planning into the transition planning process for people who will be released shortly after intake.
- Symptom Interaction. The interaction between mental and substance use disorders creates difficulties for completing an assessment of co-occurring disorders. Alcohol or drug use may create, worsen, mimic, or hide the symptoms of a mental disorder. Assessment may need to be delayed until an individual has detoxified.
Consider these key aspects of the assessment process.
The effective assessment of co-occurring disorders among people in the justice system includes the following:
- A clinical examination aided by a standardized instrument and information from collateral sources.
- Gathering information related to the scope and interaction of co-occurring disorders.
- Identifying other health conditions and complicating factors, such as cognitive deficits.
- Determining an individual's strengths and weaknesses, such as positive family support or chronic unemployment.
- Handling complicating factors, such as the short time that jails have to complete an assessment.
Resources and Links
Substance Abuse Treatment for Adults in the Criminal Justice System: Treatment Improvement Protocol (TIP) Series 44
This monograph provides guidelines for screening and assessment, triage, treatment planning, and more for people with substance use and co-occurring mental disorders under supervision by various criminal justice agencies, including jails, prisons, pretrial and diversion services, and community corrections.
Domains of Assessment for Co-Occurring Disorders: General Guidance for Assessment: OMH and OASAS Guidance Document
This resource reviews key concepts, goals, and domains for the assessment of co-occurring disorders in outpatient clinics licensed by the New York State Office of Mental Health and Office of Alcoholism and Substance Abuse Services.
The VA National Center for PTSD web pages on assessment provide reviews of trauma exposure and post-traumatic stress disorder instruments. Separate assessment pages are directed to a general audience and to behavioral health practitioners.