1. SCREENING DIAGNOSING TREATING
Dr. Geoffrey Twitchell, Director of Treatment and Clinical Services
San Diego County Probation Department
California Association of Pretrial Services Conference
May 15, 2015

2. Goals Substance Abuse and Mental Illness in Offender Populations
Screening Tools
Interviewing and Brief Interventions

3. Disproportionate Offender Rates for SMI and SUD
Sources: “The Numbers Count: Mental Disorders in America,” National Institute of Mental Health, “Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders,” National Institute of Health, “Substance Dependence, Abuse, and Treatment of Jail Inmates – 2002,” Bureau of Justice Statistics, July “Characteristics of Parole and Probation Admissions Aged 18 or Over,” The TEDS Report, Substance Abuse and Mental Health Services Administration, March 2011

4. Jails: The New Psych Hospitals
Source: “More Mentally Ill Persons are in Jails or Prisons Than Hospitals,” Treatment Advocacy Center and National Sheriff’s Association, May 2010.

5. MAYSI-2 Data at KMJDF

6. Screening Versus Assessment
Screening Tools- Instruments designed to identify individuals who are at-risk of having a particular problem and/or need and determine if a further assessment is warranted.
Standardized instrument
Typically quick
Easy to administer and score by anyone
Does not provide a diagnosis
Assessment Tools- Instruments that are used to define the nature of a problem and assists with developing specific treatment recommendations for addressing the problem.
Conducted by a qualified individual with the appropriate credentials
Can be used to assist with diagnosing an individual
Can be used to link individuals to the appropriate services based on diagnosis

7. Screening Tools AOD Screening Tools Mental Health Screening Tools
CAGE-AID- 2 minutes
TCUDS-II- 5 minutes
SSI-SA- 10 minutes
Mental Health Screening Tools
BJMHS- 5 minutes
CMSH-M/W- 5 minutes
Mental Health Screening Form III
Modified Mini Screen
Co-occurring Disorders Screening Tools
GAIN-SS- 5 minutes
PRISM- 60 minutes
Risk/Need Screening Tools
ORAS-PAT- 2 minutes
RANT- 15 minutes
LSI-R:SV 5 minutes

8. AOD Screening Tools
CAGE-AID

9. AOD Screening Tools
TCUDS V

10. AOD Screening Tools
TCUDS V Scoring

11. Mental Health Screening Tools

12. Mental Health Screening Tools
CMHS-M
CMHS-W

13. Mental Health Screening Tools
Mental Health Screening Form III

14. Mental Health Screening Tools
Modified Mini Screen (MMS)

15. Mental Health Screening Tools
Modified Mini Screen (MMS)

16. Mental Health Screening Tools
Modified Mini Screen (MMS)

17. Co-occurring Disorder Screening Tool
GAIN-SS

18. Risk/Need Screening Tool
ORAS-PAT

19. Risk-Need-Responsivity (RNR Model)
Risk Principle- Interventions to match assessed level of risk
Need Principle- Interventions to target criminogenic factors associated with behaviors
Responsivity Principle- Interventions to match offender characteristics
*Use validated assessment tools for identifying Risk and Need; Static and Dynamic (e.g. COMPAS, Static 99, RM2000)

20. COMPAS Assessment
Probation assesses for Risk and Need using the COMPAS assessment
Probation then links offenders to treatment and intervention services based on their specific Risk and Needs
Risk- Violence and Recidivism
Need- Criminogenic Needs

21. Criminogenic Needs Assessment Analysis
75% of realigned offenders supervised by Probation have needs related to substance abuse
64% have needs related to criminal thinking
52% have needs related to residential instability
44% have needs related to vocational/educational
*Data from Probation’s Needs Assessment Analysis for High Risk Offenders, San Diego County Probation Department, 2013

22. Linking Offenders to Services
The referral is made through COMPAS and the Provider receives the referral through Probation’s Community Resource Directory.

23. Community Resource Directory (CRD)
The CRD is an electronic catalog of service providers
Probation officers make online referrals to community services based on assessed risk and highest criminogenic needs according to evidence based principles
GOALS of the CRD
Supports probation officer’s role as a case manager
Assists in the delivery of services to offenders in pursuit of rehabilitation
Allows for measurement of offender participation and progress in treatment

24. CRD Referral to Treatment/Services

25. Dual Diagnosis/ Co-occurring Disorders
Approximately 8.9 million adults have co-occurring disorders
Bipolar Disorder, Schizophrenia and PTSD show higher rates of substance abuse
Only 7.4 % receive treatment for both conditions; % receive no treatment at all
Integrated, simultaneous treatment produces better outcomes for individuals with co- occurring mental and substance use disorders.

26. Services Integration for Co-occurring Disorders
Means providing at a minimum:
Integrated screening for substance use and mental health disorders
Integrated assessment
Integrated treatment planning
Integrated or coordinated treatment
Continuing care

27. Screening, Brief Intervention and Referral to Treatment (SBIRT)
Comprehensive, integrated public health approach to early intervention and treatment
Screening: quickly assesses severity of substance use and identifies appropriate level of treatment
Brief intervention: focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
Referral to treatment: provides those identified as needing more extensive treatment with access to specialty care

28. Screening
Simple method of identifying individuals who are drinking/using drugs at at-risk levels as well as those who are already experiencing AOD-related problems
Gives specific information and feedback about AOD
Provides opportunity to educate the individual about their use and the consequences it has/will generate
It offers the individual an opportunity to change their behavior to prevent progression

29. SBIRT Process

30. Brief Intervention Providing information and feedback about results
Understanding individuals’ views of their use
Encouraging the individual to discuss their views on their likes and dislikes about use, and how they may consider changing.
Respectfully advising individual to decrease or abstain
Teaching behavior change skills
Establishing a method for follow-up with the individual.

31. Referral to Treatment Consists of assisting individuals with:
Accessing specialized treatment
Selecting treatment facilities
Obtaining authorizations from insurance if needed
And, in some cases, providing transportation

32. SBIRT Effectiveness

33. SBIRT Videos
How to do SBIRT ?
How NOT to do SBIRT

34. Stages of Change

35. Motivational Interviewing
Motivational Interviewing Techniques:
 MI Principles:
Express Empathy
Develop Discrepancy
Roll with Resistance
Support Self-Efficacy
MI Fundamental Skills (OARS):
Open Ended Questions
Affirmations
Reflections
Summarizations   
Bill Miller

36. MI Videos
How to do MI
How NOT to do MI

37. References Brief Jail Mental Health Screen (BJMHS)
Correctional Mental Health Screen - Men and Women (CMHS-M/W)
Cutdown, Annoyed, Guilty, Eye-Opener: Adapted to Include Drugs (CAGE-AID)
Global Appraisal of Individual Needs-Short Screener (GAIN-SS)
Level of Service Inventory-Revised: Screening Version (LSI-R:SV)
Mental Health Screening Form III
Modified Mini Screen
Ohio Risk Assessment System: Pretrial Assessment Tool (ORAS-PAT)
Psychiatric Research Interview Substance and Mental Disorders (PRISM)
Risk and Needs Triage (RANT)
Simple Screening Instrument for Substance Abuse (SSI-SA)
Texas Christian University Drug Screen (TCUDS-II)

38. Director of Treatment and Clinical Services
THANK YOU!
Geoff Twitchell, Ph.D.
Director of Treatment and Clinical Services
Telephone: (858)