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Co-Occurring Disorders in Criminal Justice Settings

Integrated Screening for Co-Occurring Disorders in Criminal Justice Settings

Screening for co-occurring disorders identifies people who are likely to have mental or substance use disorders. Co-occurring disorders screening helps agencies determine what considerations a person needs at intake. For example, a person who shows signs and symptoms of mental and substance use disorders needs specific considerations, such as treatment, supervision, and placement.

Screening helps the agency detect symptoms and behaviors, and determine whether they are related to co-occurring disorders. Screens do not confirm a person has a disorder. They only identify the possible presence of mental or substance use disorders.

Information collection should begin at entry.

Criminal justice agencies with effective screening procedures for co-occurring disorders start collecting information at entry. This is done as part of the intake screening process. The type of information collected varies by setting (e.g., jail, court, or probation) and has different purposes, such as security classification in jails, pretrial detention in courts, and presentence investigation by probation.

Many mental and substance use disorders screens are designed to be delivered by a trained clinician. These screens can be delivered as part of a medical screening process separate from an agency's general intake screening. Some screens are designed to be delivered by non-clinicians. For example, jail booking officers deliver the Brief Jail Mental Health Screen.

Routine processes with reliable screens produce accurate results.

Criminal justice settings achieve accurate and reliable results by using a routine process and screens with established validity. The process may involve a single screen for co-occurring disorders (e.g., BASIS-24 exit disclaimer) or separate screens for mental (e.g., Modified MINI exit disclaimer) and substance use disorders (e.g., Simple Screening Instrument).

The screening process can also identify deficits in functioning and an individual's use of behavioral health services and medications. If screening reveals the possibility of mental or substance use disorders, an effective protocol directs the practitioner or officer to make a referral for a follow-up assessment. The process also involves steps for responding to a behavioral health crisis, such as acute intoxication or when people are at risk to harm themselves or others.

Record review informs the screening process.

Reviewing a person's health care record from previous experiences with criminal justice settings is a good way to inform the screening process. For example, a jail may check the day's booking roster against the records of the jail's health care provider. A criminal justice agency may share information with other criminal justice agencies to integrate the screening and assessment process. Information-sharing agreements can also be formed with behavioral health providers. These agreements spell out what information is accessible to each agency. In some cases, agreements include only one-way information sharing.

Remember these key aspects of the screening process.

Screening for co-occurring disorders is part of a larger treatment and supervision planning process that includes assessment and diagnosis. As part of the full protocol, an effective screening process includes the following:

  • Routine screening at the entry points to criminal justice settings.
  • Use of standardized instruments that include cut-off points to determine whether a person should be referred for a follow-up assessment.
  • Staff persons trained to administer the screening instruments and refer people for assessment.
  • A response for people experiencing a behavioral health crisis, such as intoxication or drug use that requires medical attention, or if an individual is experiencing suicidal thoughts.
  • Reference to health care records maintained by the agency conducting the screening. These are available from other criminal justice settings (e.g., a court clinic) or through an information-sharing agreement with local behavioral health providers.

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