Screening and Assessing Co-Occurring Disorders. (Juvenile Justice News)
Underwood, Lee A., Falwell, Sally H., Corrections Today
There is an urgent need for proper guidelines, testing and interview materials, and acceptable procedures for youth's treatment upon entering the juvenile justice system. Often, adolescent offenders are quickly shuffled through court proceedings and into the juvenile justice system, where others before them are either awaiting proper screening and assessment, or receiving improper treatment. Generally, screening and assessment materials serve different purposes in diagnosis, treatment planning, risk, classification, remediation and referrals. Proper screening and assessment of youths should result in appropriate and effective treatment planning.
In addition to the need for guidelines and testing procedures, there is a lack of psychological tests for screening and assessing co-occurring mental health and substance abuse disorders. The term co-occurring is consistently used to describe the existence of two or more disorders. One disorder always is substance use and the second always is a clinical syndrome or mental health disorder. Information gathered from instruments that target separate areas might delay or prevent proper treatment for youths who have co-occurring mental health and substance abuse disorders. Limited screening and assessment information may complicate treatment interventions, as youths with co-occurring disorders often have an elevated risk for impulsive and aggressive behavior. These behaviors complicate treatment and rehabilitation; they negatively impact youths' ability to adjust and transition to adulthood. The result is a population of youths who have slipped through the cracks, unable to receive effective treatment for their sp ecific disorders. Thus, there is an urgency added to the need for screening and assessment methodology acutely designed to highlight co-occurring mental health and substance abuse issues to prevent these youths from further penetrating the juvenile justice system.
Despite the need for screening and assessment procedures that detect co-occurring disorders, there are few tests that provide an integrated analysis of these frequently overlooked areas. Implementing a standard of procedures for screening and assessing co-occurring disorders involves specialized and skillful processes across a wide range of service systems and providers (lsaacs, 1992; Peters and Hills, 1997).
Screening and assessment tests should measure emotional, behavioral, chemical and criminal characteristics linked to problems in an individual's or family's overall functioning. There also are the issues of fidelity (exactness), reliability and validity of any instrument meant to detect co-occurring disorders. Because there is a lack of normative data, researchers and practitioners struggle to compare results from an instrument that measures co-occurring disorders with instruments that examine mental health and substance use issues separately.
Four steps in choosing and implementing a screening and assessment battery, including three possible combinations of existing tests for screening and assessing juvenile offenders, are summarized below. Since there are few tests available that accurately assess co-occurring disorders, the combination of tests in each option explores issues in a modulated fashion (by necessity), but seeks to address the frequently overlooked areas that cause youths to undergo improper treatment.
The first step in selecting a psychometrically sound, theoretically and clinically useful test is working from a basis of select principles. This section proposes five basic principles that provide a foundation for test selection.
First, tests should be chosen to provide the necessary emotional, behavioral and juvenile justice information; they would be relevant to developing, implementing and monitoring comprehensive treatment plans. When possible, the combination of tests should identify information concerning behavioral issues, family dynamics, peer group association risk factors and other critical developmental issues (Sue and Sue, 1999). …