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Screening and Assessment of Co-Occurring Disorders in the Justice System

Prevalence and Significance of Co-occurring Disorders in the Justice System

1. The significant growth in the justice system has resulted from changes in drug laws and law enforcement practices and from the absence of public services for people who have mental or substance use disorders, who are homeless, and who are impoverished.

A. True

B. False


2. Studies indicate that _____ of justice involved individuals who have severe mental disorders also have co-occurring substance use disorders.

A. 60 - 87%

B. 24 - 34%

C. 17 - 34%

D. 10 - 15%


3. People with CODs often engage in drug use to alleviate symptoms associated with serious mental disorders, including:

A. Depression

B. Anxiety

C. Paranoia

D. All of the above


4. Participants in correction-based treatment programs for CODs often show positive treatment outcomes, including lower dropout rates in comparison to community treatment programs.

A. True

B. False


Defining Co-occurring Disorders

5. Mixing people who have more predatory characterological disorders in specialized CODs programs with others who have significant impairment related to bipolar disorders, depression, or psychosis may be problematic for which reason?

A. People with pronounced characterological disorders may be at higher risk for criminal recidivism, and it is contraindicated to combine offenders who are at significantly different risk levels in treatment and supervision services.

B. People with more severe impairment related to CODs are frequently victimized while in the justice system and may be more vulnerable to emotional and physical abuse when placed with offenders who are at higher criminal risk levels.

C. People with more severe impairment related to their mental or learning disorders require distinctive interventions, including medication management, basic life skills training, crisis stabilization, and intensive case management.

D. All of the above.


6. An important new criterion for substance use disorders is _____, reflecting factors surrounding the intensity of desire for ongoing substance use.

A. Dependence

B. Legal difficulties from drug use

C. Cravings

D. All of the above


7. As a result of the intertwined nature of mental and substance use disorders among people in the justice system, it is critically important to:

A. Determine if mental health symptoms appeared after engaging in substance use.

B. Assess whether engaging in substance use was motivated by attempts to alleviate symptoms of mental disorders.

C. Investigate the presence of mental health symptoms following periods of abstinence to help determine if there is a causal relationship between the mental and substance use disorders.

D. All of the above.


Importance of Screening and Assessment for Co-occurring Disorders in Justice Settings

8. In some justice settings, identification of CODs is aided by parallel screening and assessment activities for mental and substance use disorders, as this approach often leads to detection of CODs and other related issues, information sharing, enhanced communication regarding overlapping areas of interest, development of integrated services goals that address both mental health and substance use issues.

A. True

B. False


Opportunities for Screening and Assessment

9. Opportunities to train responders in the identification of the signs and symptoms of mental and substance use disorders and to more quickly resolve crisis situations have more operational value than adding extensive screening procedures.

A. True

B. False


10. Jails are required to conduct at least basic screening for all of the following, except:

A. Suicide

B. Criminal risk

C. Mental health

D. Substance use


11. Planning for reentry should begin at:

A. Initial detention

B. First appearance court

C. Jail booking

D. Dispositional court


Defining Screening and Assessment

12. Which of the following describes the role of screening?

A. It is implemented when there is a need for more detailed information to help place people in a specific level of care or type of service.

B. It addresses immediate needs for services.

C. It informs treatment planning or case planning.

D. It examines a range of long-term needs and factors that may affect engagement and retention in services, such as housing, vocational and educational needs, transportation, family and social supports, motivation for treatment, and history of involvement in behavioral health services.


13. Assessment for CODs is a brief, routine process designed to identify indicators, or “red flags,” for the presence of mental health, substance use, or other issues that reflect an individual’s need for treatment and for alternative types of supervision or placement in housing or institutional settings.

A. True

B. False


14. Assessment in the criminal justice setting should be conducted by individuals who:

A. Are knowledgeable about the dynamics of criminal behavior.

B. Understand the pathways and interactions between criminal behavior and clinical pathology related to substance use and mental disorders.

C. Both (A) and (B).

D. None of the above.


15. Goals of the CODs assessment process include all of the following, except:

A. Determination of need and prescribing appropriate medication.

B. History of previous mental health or substance use treatment(s) and response to treatment(s).

C. Family history of mental health or substance use disorders.

D. Development of diagnoses according to formal classification systems.


16. Which of the following types of information should be examined in assessing CODs within the justice system?

A. Juvenile and adult justice system history and current status.

B. Reasons for living.

C. Trauma exposure, including combat, non-combat, and general trauma.

D. All of the above.


17. Assessment of substance use should include:

A. Misuse of prescription drugs.

B. Reasons for substance use.

C. Periods of abstinence.

D. All of the above.


Developing a Comprehensive Screening and Assessment Approach

18. In the absence of specialized instruments to address both disorders, an integrated screening approach typically involves use of a combination of mental health and substance use instruments.

A. True

B. False


19. Integrated screening and assessment approaches are associated with more favorable outcomes among people in the justice system and in the community, and help to maximize the use of scarce treatment resources.

A. True

B. False


Key Information To Address in Screening and Assessment for Co-occurring Disorders

20. All of the following characteristics carry elevated risk for CODs, except for:

A. Female gender

B. Youthful offender status

C. Low educational achievement

D. History of unstable housing or homelessness


21. Related areas of functional ability include all of the following, except for:

A. Reading skills

B. Writing skills

C. Prosocial leisure skills

D. How the individual responds to confrontation or stress and manages unusual thoughts and impulses


Enhancing the Accuracy of Information in Screening and Assessment

22. Accuracy of information obtained during screening and assessment can be compromised by which of the following factors?

A. Incomplete, mislabeled, or misleading clinical or criminal justice records.

B. The transparent nature of screening and assessment instruments may lead to individuals providing false information.

C. Symptoms may be feigned or exaggerated if an offender believes this will lead to more favorable placement or disposition.

D. All of the above.


23. Screening and assessment of mental and substance use disorders in the justice system is most often based on self-report information, however, self-report information obtained from justice-involved individuals has been found to be invalid and not useful for treatment planning.

A. True

B. False


24. Strategies for maximizing the accuracy of self-report information include all of the following, except for:

A. Providing clear instructions regarding the screening and assessment process.

B. Asking about “typical” or “usual” substance use patterns rather than specifying a time frame related to past substance use.

C. Establishing rapport through use of motivational interviewing and other related techniques.

D. Carefully explaining the scope of and limits to confidentiality and the potential consequences for reporting mental health and substance use problems.


25. Observation by family members, friends, and direct care staff cannot provide information  that is as accurate as data compiled from interviews or standardized instruments.

A. True

B. False


26. While the DSM-IV-TR and DSM-5 indicate that individuals should be abstinent for approximately _____ before an accurate mental health diagnosis can be provided, the precise length of the extended baseline for screening and assessment should be determined by the severity of the symptoms and the general health status.

A. 10 days

B. 4 weeks

C. 8 weeks

D. 3 months


Special Clinical Issues in Screening and Assessment for Co-occurring Disorders in the Justice System

27. The “Risk Principle” indicates that the intensity of services provided by CODs programs should be proportional to the risk of recidivism, and that the most intensive services should be reserved for the higher risk offenders.

A. True

B. False


28. The major criminogenic needs include all of the following, except for:

A. Antisocial attitudes, personality features, and friends and peers

B. Poor employment skills

C. Low self-esteem

D. Lack of prosocial leisure activities


29. The capability factor of the Suicide Risk Decision Tree framework is the acquired ability to engage in self-harm, which is influenced by all of the following, except:

A. Desire to feel pain

B. Fearlessness of death

C. Suicidal plans and preparations

D. Duration and intensity of suicidal ideation


30. Consequences of not screening for trauma include:

A. Inappropriate treatment referral

B. Dropout from treatment

C. Premature termination of treatment

D. All of the above


31. Given that two-thirds of incarcerated women are from cultural or ethnic minorities, screening and assessment approaches should be selected that are culturally valid and sensitive.

A. True

B. False


32. Motivation to engage in treatment is necessary to provide effective services for justice-involved individuals.

A. True

B. False


33. The purpose of motivational interviewing is to:

A. Normalize ambivalence towards change.

B. Develop discrepancy between the offenders’ current attitudes and behaviors and their values and goals.

C. Both (A) and (B).

D. None of the above.


34. Important cultural themes to consider during the assessment and treatment process include:

A. Religiosity and related beliefs and customs.

B. Independent versus interdependent cultural orientations.

C. Trust versus distrust of authority figures.

D. All of the above.


Comparing Screening Instruments

35. All of the following instruments were found to be the most effective in identifying individuals with substance use disorders, as determined by the SCID diagnostic interview, except for:

A. The Drug Abuse Screening Test (DAST-20)

B. The Simple Screening Instrument (SSI)

C. The Texas Christian University Drug Dependence Screen V (TCUDS V)

D. A combined measure consisting of the Alcohol Dependence Scale (ADS) and Addiction Severity Index (ASI) - Drug Use section


Recommended Screening Instruments

36. All of the following are recommended screening instruments for co-occurring disorders, except for:

A. Mini International Neuropsychiatric Interview-Screen (MINI-Screen)

B. The Simple Screening Instrument (SSI)

C. Brief Jail Mental Health Screen (BJMHS) and TCU Drug Screen V (TCUDS V)

D. Correctional Mental Health Form (CMHS-F/CMHS-M) and TCU Drug Screen V (TCUDS V)


Screening Instruments for Substance Use Disorders

37. Substance use screens are somewhat vulnerable to manipulation by those seeking to conceal substance use problems, and concurrent use of drug testing is recommended to generate the most accurate screening information.

A. True

B. False


38. Only _____ of the 25 ADS items may be needed to make a reliable classification in high-risk alcohol drinkers, and ADS items addressing excessive drinking are the most useful in making this classification.

A. 3

B. 6

C. 9

D. 12


39. The ADS:

A. Has been found to perform adequately in community settings.

B. Examines quantity and frequency of recent and past alcohol use.

C. Exhibits substantial agreement across types of reporting, such as self-report and report by service/agency staff.

D. All of the above.


40. Studies indicate that the AUDIT examines which major factor?

A. Alcohol consumption

B. Drinking behaviors

C. Consequences of drinking

D. All of the above


41. The AUDIT provides cut-off scores that indicate alcohol severity and risk level, interpretation of these cut-off scores, and treatment recommendations.

A. True

B. False


42. At a cut-off score of 1 or 2, the CAGE exhibits which of the following in classifying alcohol use disorders among patients who have schizophrenia?

A. Good sensitivity

B. Specificity

C. Positive predictive value

D. All of the above


43. The CAGE has lower sensitivity in diagnosing alcohol use disorders in inpatient populations than in other settings.

A. True

B. False


44. The CAGE has higher sensitivity among Whites than African Americans.

A. True

B. False


45. The DAST can distinguish between individuals with primary alcohol problems, those with primary drug problems, and those with both sets of problems.

A. True

B. False


46. The SSI examines all of the following domains related to severe substance use disorders, except for:

A. Alcohol and drug consumption

B. Quantity and frequency of recent and past substance use

C. Preoccupation and loss of control

D. Adverse consequences


47. The SASSI was found to be the most effective of eight screening instruments in identifying severe substance use disorders among incarcerated offenders.

A. True

B. False


48. When administering the TCUDS with incarcerated individuals, it may be useful to concurrently screen for deception, as approximately 7% of responses may be invalid due to “faking good,” and _____% of responses may be invalid due to “faking bad.”

A. 2

B. 5

C. 8

D. 16


Screening Instruments for Mental Disorders

49. Among people with substance use problems, the BDI-II exhibits all of the following in diagnosing depression, except for:

A. Good sensitivity

B. Specificity

C. Positive predictive value

D. The BDI-II exhibits all of the above


50. The BJMHS screens for:

A. Severe mental disorders

B. Anxiety

C. Personality disorders

D. All of the above


51. The MHSF-III has outperformed the Co-occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD) and the Modified Mini Screen-MMS (MINI-M) in overall accuracy and sensitivity in detecting mental disorders.

A. True

B. False


Screening Instruments for Co-occurring Mental and Substance Use Disorders

52. The difference between the MINI Screen and the MMS is that the MMS does not include items aimed at screening for:

A. Mood disorders

B. Drug/alcohol use disorders

C. Anxiety disorders

D. Psychotic disorders


Screening and Assessment Instruments for Suicide Risk

53. Which of the following more effectively predicts multiple suicide attempts than other suicide risk instruments?

A. BSS

B. RASQ

C. ASIQ

D. None of the above


Screening and Diagnostic Instruments for Trauma and PTSD

54. The PCL can be used to monitor change in symptoms over time, particularly in treatment settings.

A. True

B. False


Assessment Instruments for Substance Use and Treatment Matching Approaches

55. Research indicates that the ASI is reliable and valid for use with people who have CODs.

A. True

B. False


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