SCREENING DIAGNOSING TREATING Dr. Geoffrey Twitchell, Director of Treatment and Clinical Services...
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SCREENING DIAGNOSING TREATING Dr. Geoffrey Twitchell, Director of Treatment and Clinical Services San Diego County Probation Department California Association
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
Slide 2
Goals Substance Abuse and Mental Illness in Offender
Populations Screening Tools Interviewing and Brief
Interventions
Slide 3
Disproportionate Offender Rates for SMI and SUD Sources: The
Numbers Count: Mental Disorders in America, National Institute of
Mental Health, 2006. Prevalence and Co-Occurrence of Substance Use
Disorders and Independent Mood and Anxiety Disorders, National
Institute of Health, 2006. Substance Dependence, Abuse, and
Treatment of Jail Inmates 2002, Bureau of Justice Statistics, July
2005. Characteristics of Parole and Probation Admissions Aged 18 or
Over, The TEDS Report, Substance Abuse and Mental Health Services
Administration, March 2011
Slide 4
Jails: The New Psych Hospitals Source: More Mentally Ill
Persons are in Jails or Prisons Than Hospitals, Treatment Advocacy
Center and National Sheriffs Association, May 2010.
Slide 5
MAYSI-2 Data at KMJDF
Slide 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
Mental Health Screening Tools Mental Health Screening Form
III
Slide 14
Mental Health Screening Tools Modified Mini Screen (MMS)
Slide 15
Mental Health Screening Tools Modified Mini Screen (MMS)
Slide 16
Mental Health Screening Tools Modified Mini Screen (MMS)
Slide 17
Co-occurring Disorder Screening Tool GAIN-SS
Slide 18
Risk/Need Screening Tool ORAS-PAT
Slide 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)
Slide 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
Slide 21
Criminogenic Needs Assessment Analysis *Data from Probations
Needs Assessment Analysis for High Risk Offenders, San Diego County
Probation Department, 2013
Slide 22
Linking Offenders to Services The referral is made through
COMPAS and the Provider receives the referral through Probations
Community Resource Directory.
Slide 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 Supports
probation officers 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
GOALS of the CRD
Slide 24
CRD Referral to Treatment/Services
Slide 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; 55.8 % receive no
treatment at all Integrated, simultaneous treatment produces better
outcomes for individuals with co- occurring mental and substance
use disorders.
Slide 26
Services Integration for Co-occurring Disorders Means providing
at a minimum: 1.Integrated screening for substance use and mental
health disorders 2.Integrated assessment 3.Integrated treatment
planning 4.Integrated or coordinated treatment 5.Continuing
care
Slide 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
Slide 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
Slide 29
SBIRT Process
Slide 30
Brief Intervention 1.Providing information and feedback about
results 2.Understanding individuals views of their use
3.Encouraging the individual to discuss their views on their likes
and dislikes about use, and how they may consider changing.
4.Respectfully advising individual to decrease or abstain
5.Teaching behavior change skills 6.Establishing a method for
follow-up with the individual.
Slide 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
Slide 32
SBIRT Effectiveness
Slide 33
SBIRT Videos How NOT to do SBIRT How to do SBIRT ?
Slide 34
Stages of Change
Slide 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
Slide 36
MI Videos How to do MI How NOT to do MI
Slide 37
References 1.Brief Jail Mental Health Screen (BJMHS)
http://gainscenter.samhsa.gov/pdfs/disorders/bjmhsform.pdf
2.Correctional Mental Health Screen - Men and Women (CMHS-M/W)
http://www.asca.net/system/assets/attachments/2639/MHScreen-Men082806.pdf?1300974667
http://www.asca.net/system/assets/attachments/2640/MHScreen-Women082806.pdf?1300974694
3.Cutdown, Annoyed, Guilty, Eye-Opener: Adapted to Include Drugs
(CAGE-AID) http://www.agencymeddirectors.wa.gov/Files/cageover.pdf
4.Global Appraisal of Individual Needs-Short Screener (GAIN-SS)
http://www.gaincc.org/products-services/instruments-reports/
5.Level of Service Inventory-Revised: Screening Version (LSI-R:SV)
http://www.mhs.com/product.aspx?gr=saf&prod=lsi-rs&id=overview
6.Mental Health Screening Form III
https://www.idph.state.ia.us/bh/common/pdf/substance_abuse/integrated_services/jackson_mentalhealth_screeningtool.pdf
7.Modified Mini Screen
http://www.nyc.gov/html/doh/downloads/pdf/qi/qi-mms-scoringsht.pdf
8.Ohio Risk Assessment System: Pretrial Assessment Tool (ORAS-PAT)
http://www.pretrial.org/download/risk-assessment/Ohio%20Pretrial%20Risk%20Assessment%202009.pdf
9.Psychiatric Research Interview Substance and Mental Disorders
(PRISM) http://www.columbia.edu/~dsh2/prism/ 10.Risk and Needs
Triage (RANT)
http://www.tresearch.org/tools/for-courts/rant/about-rant/
11.Simple Screening Instrument for Substance Abuse (SSI-SA)
http://www.prairie-center.com/files/images/sasf.pdf 12.Texas
Christian University Drug Screen (TCUDS-II)
https://www.dpscs.state.md.us/publicservs/procurement/QA_5_ATTACHMENT_1_TCU_DRUG_SCREEN.pdf
Slide 38
Geoff Twitchell, Ph.D. Director of Treatment and Clinical
Services [email protected] Telephone: (858) 514-3175
THANK YOU!