KAP KEYS Based on TIP 44 Substance Abuse Treatment for Adults in the Criminal Justice System

KAP KEYS Based on TIP 44 Substance Abuse Treatment for Adults in the Criminal Justice System – KAP Keys were developed to accompany the Treatment Improvement Protocol (TIP) Series published by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA). These KAP Keys are based entirely on TIP 44 and are designed to meet the needs of the busy clinician for concise, easily accessed “how-to” information.

Common Myths About Screening and Assessment

Following are several common myths about substance abuse screening and assessment, and the facts that debunk those myths.

• Myth: Screening and assessment are no better than intuition in detecting a person’s need for treatment.

Fact: Objective screening and assessment measures can result in treatment that is better targeted to a client’s needs, resulting in better outcomes.

• Myth: Only a single screening is needed to place people in different levels of treatment services.

Fact: Accurate evaluation requires a battery of instruments that examine how substance use has affected all the domains of the client’s life. When treatment options are severely limited, however, a basic screening may be sufficient to determine eligibility and suitability for treatment.

• Myth: Untrained professionals can conduct screening and assessments.

Fact: Although some screenings can be administered and scored without significant training, placement decisions are greatly improved when they are made by professionally trained staff. This includes staff with relevant certification in substance abuse treatment, those with advanced professional degrees, and those with specialized training in the use of particular screening and assessment instruments. For those screening and assessment approaches that require an interview with the offender, specialized training is also needed in basic counseling techniques such as rapport building and reflective listening. Use of trained professional staff in the triage and placement process helps to minimize the number of inappropriate referrals for treatment.

• Myth: Screening and assessment are always compromised because you cannot trust self-report information from offenders.

Fact: Research generally validates the reliability, and to some degree, the validity of information obtained through self-reports. Collateral sources such as the offender’s family and friends can improve the reliability of the information gathered (or “the full picture”). Offenders do supply a certain amount of misinformation in some settings to avoid unwanted consequences, however.

• Myth: All screening and assessment instruments are equally effective.

Fact: Research shows significant variability in the reliability and validity of different instruments with different populations.

• Myth: Because an instrument is widely used, it must be effective.

Fact: Many highly marketed and widely used instruments do not have a research base supporting the validity of their use. In fact, many of the widely marketed and used instruments have been shown to be less effective than those available in the public domain.

• Myth: Screening and assessment should not examine the history of physical and sexual abuse and related trauma because this may aggravate the offender’s level of stress and psychological instability, and staff may not be able to deal effectively with the consequences.

Fact: Screening and assessment of all forms of abuse are essential for both male and female offenders, because it is now recognized that the effects of trauma contribute to many psychiatric disorders. Clinical outcomes are likely to be compromised if these abuse and trauma issues are not explored and if strategies addressing these issues are not developed and integrated into treatment plans for mental and substance use disorders.

However, it is important to emphasize that in screening for a history of trauma it can be damaging to ask the client to describe traumatic events in detail. To screen, it is important to limit questioning to very brief and general questions, such as “Have you ever experienced childhood physical abuse? Sexual abuse? A serious accident? Violence or the threat of it? Have there been experiences in your life thwasere so traumatic they left you unable to cope with day-to-day life?”

Screening Guidelines by Domain

Screening content should identify key issues that need to be addressed in placing offenders in treatment. Content can be specific to several domains, including substance use, criminal involvement, physical health, mental health, and special considerations.

Domain Indicators

Substance Use • Substance use history
• Motivation and desire for treatment
• Severity and frequency of use
• Detoxification needs, acute intoxication
• Treatment history (e.g., number and type of episodes, outcomes)

Criminal Involvement • Criminal thinking
• Current offense(s)
• Prior charges
• Prior convictions
• Age at first offense
• Type of offense(s)
• Number of incarcerations
• Prior successful completion of probation or parole drug use offenses
• Prior involvement in diversionary programs
• History of diagnosis of any personality disorder

Health

• Intoxication, infectious disease (tuberculosis, hepatitis, sexually transmitted diseases, HIV status)
• Pregnancy
• General health
• Acute conditions