NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

1. TIP 44: Adults in the
Criminal Justice System
Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC
Copyright 2008-2012
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2. Screening and Assessment
Copyright 2008-2012
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3. Purpose

◦ Screen out offenders who do not need treatment
◦ Assess the extent of offenders’ treatment needs
◦ Gather information for wrap-around referrals
◦ Determine eligibility and suitability
Information sources

◦ Booking records
◦ Interview
◦ Instruments
◦ Correctional records/presentence investigations
◦ Past treatment records
◦ Police reports
◦ Drug Tests
Screening Copyright 2008-2012
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4. Accuracy of information

Continuity and system-wide sharing of

information
The importance of re-screening and re-

assessing
Timing of screening and assessment

Drug testing

Detoxification needs

Readiness for treatment

History of trauma

Psychopathy

Risk for violence

Recidivism

Screening Areas of Concern Copyright 2008-2012
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5. Stigma

 Inaccuracy due to withdrawal
 SA diagnosis may preclude from MH
treatment
 SA diagnosis may limit offenders access
to work assignments or vocational
training/rehab
Diagnosis Pitfalls Copyright 2008-2012
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6. Reimbursement

To support pharmacological interventions

When psychiatric concerns emerge

Clarification of co-occurring disorders

Research/evaluation

Reasons for Diagnosis Copyright 2008-2012
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7. Explain that diagnosis is just short hand

 Review presenting issues and discuss
differential diagnosis
 Normalize diagnoses
◦ Google ―Famous people with…‖
Do an ―All About Me‖ worksheet

De-stigmatizing Diagnosis Copyright 2008-2012
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8. Instruments with adequate reliability and

validity with incarcerated populations
Reproduced in appendix C of TIP 44

◦ Addiction Severity Index–Alcohol Use subscale
(ASI-Alcohol)
◦ ASI–Drug Use subscale (ASI-Drug)
◦ Drug Abuse Screening Test (DAST-20)
◦ Michigan Alcoholism Screening Test (MAST)
Simple Screening Instrument for Substance

Abuse (SSI-SA)—Reproduced in TIP 42 (CSAT
2005)
Screening Instruments Copyright 2008-2012
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9. Addictions Severity Index

◦ reproduced in TIP 38, Integrating (CSAT 2000)
◦ structured interview format (75 minutes)
◦ examines the following areas of functioning:
 Drug/alcohol use
 Relationships
 Employment
 Legal involvement
 Physical health
 Mental health
Assessment Instruments: ASI Copyright 2008-2012
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10. SA

◦ Substance use history
◦ Motivation
◦ Severity and frequency of use
◦ Detoxification needs
◦ Treatment history
Criminal Involvement

◦ Criminal thinking
◦ Current and prior offense(s) types and numbers
◦ Prior successful completion of probation for drug
use offenses
◦ Prior involvement in diversionary programs
◦ History of diagnosis of any personality disorder
Assessment Areas Copyright 2008-2012
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11. Health

◦ Intoxication
◦ Infectious disease
◦ Pregnancy
◦ General health
◦ Acute conditions
MH

◦ Suicidality
◦ MH diagnosis and treatment history
◦ Acute symptoms
◦ Current medications
Assessment Areas cont… Copyright 2008-2012
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12. Special Considerations

◦ Educational level
◦ Reading level/literacy
◦ Language/cultural barriers
◦ Physical disability
◦ Developmental disability
◦ Learning/cognitive disability
◦ Housing
◦ Dependants/family issues
◦ History of abuse (victim or perp)
Assessment Areas cont… Copyright 2008-2012
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13. Continuum of services

◦ Pretreatment (Detoxification)
◦ Outpatient
◦ Inpatient
Triage and Placement Copyright 2008-2012
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14. Key staff preparations

◦ Develop a treatment resource database
◦ Define eligibility and suitability for each
program
◦ Document referral process to each program
◦ MOU including
 information to be shared
 supervision and treatment responsibilities of each
party
 evaluate effectiveness of offender matching
(ongoing)
Triage and Placement cont… Copyright 2008-2012
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15. Target offenders with moderate to high

risk of recidivism
◦ Criminal history
◦ Poor employment history
◦ Poor support environment
◦ Homelessness
◦ Antisocial traits (impulsivity, lack
empathy, anger issues, entitlement)
Placement Strategies Copyright 2008-2012
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16. Moderate to severe substance abuse

problems
◦ Substance dependence
◦ SA related arrests
◦ History of SA with or without treatment
◦ Positive drug tests
Placement Strategies cont… Copyright 2008-2012
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17. Moderate to severe mental health issues

◦ Suicidal or violent behaviors
◦ Acute symptoms
◦ Cognitive impairment (concentration, problem
solving)
◦ Social impairment (interpersonal
skills, frustration tolerance
Placement Strategies cont… Copyright 2008-2012
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18. Perceived severity of problems (Readiness

for change)
 Motivation (SOCRATES*, TIP 35)
 Prior evidence of attempts to improve
 Perceived importance of treatment
*Stages of Change, Readiness, and Treatment Eagerness
Scale
Offender characteristics Copyright 2008-2012
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19. Offender involvement in treatment

planning
Motivational interviewing

Coordination with ―team‖

Plan updates at status changes

Community based linkages at re-entry

Implementing Treatment Copyright 2008-2012
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20. Outreach and low-intensity interventions

◦ Provided to all offenders
 Entrance
 As part of daily activities (webcast via TV)
 Exit/Re-entry
Implementing Treatment cont… Copyright 2008-2012
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21. Components of criminality

◦ Criminal thinking
◦ Criminal code (inmate value system)
◦ Manipulation
Criminal Thinking

◦ Learned behavior
◦ Help offenders recognize thinking errors and
understand how they can lead to behavior
◦ CBT and Staff/Peer confrontation
General CJ Treatment Issues Copyright 2008-2012
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22. Criminal Code

◦ Refusal to cooperate with authority
◦ Refusal to confront negative behavior
◦ Participation in treatment viewed as weakness
◦ ―Snitch syndrome‖
Manipulation

◦ Throwing focus
◦ Team splitting
◦ Demeaning others (Power plays)
General CJ Treatment Issues
cont… Copyright 2008-2012
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23. Addressing manipulation

◦ Identifying the primary thinking errors
observed
◦ Instructing the client to begin self-monitoring
when these occur (journaling)
◦ Providing regular feedback to the client, usually
from peers in a treatment group
General CJ Treatment Issues
cont… Copyright 2008-2012
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24. Excuse making

Blaming

Justifying

Throwing focus

―I think; therefore it is,‖ permits function

according to what he wants, rather than
according to the facts
Lying: commission/omission

Making Fools Of : pulling the wool

Build-up: focus on positives and bring down

others
General CJ Treatment Issues
cont… Copyright 2008-2012
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25. Assuming

I'm unique / It doesn’t apply to me

Ingratiating : phony manipulation

Fragmented Personality Behaviors are inconsistent

Minimizing / Exaggerating

Vagueness / Non-committal

Anger

Power plays

Victim playing

Closed channel : unreceptive, undisclosing

Ownership / lack of awareness of other’s boundaries

Image cowboy or victim

General CJ Treatment Issues
cont… Copyright 2008-2012
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26. Identifying the feeling(s)—other feelings may

be involved, such as embarrassment or guilt
Understanding clearly where the feeling is

coming from
Identifying the goals the anger is serving

(e.g., deflecting attention)
Identifying the goals the anger is

undermining (e.g., staying out of jail or
keeping a job)
Working toward taking the longer view

(e.g., beginning to use a positive/pro-social
thought process to manage the anger)
Addressing Anger and Hostility Copyright 2008-2012
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27. Assessment: inaccurate placements

Poor staff training

Staff transition

Overreliance on institutional sanctions

instead of letting peers pressure for internal
controls
Aftercare availability and compliance

Coercion

Treatment competes with other facility

opportunities
Barriers to Effective Treatment Copyright 2008-2012
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28. Pretrial Diversion

◦ Supervision in lieu of detention
◦ Treatment in lieu of prosecution
Maintain a client’s confidentiality

Avoid discussing the client’s criminal case

the client is presumed innocent before trial

Be realistic about the responsibilities that a

client is capable of handling
Avoid allowing individuals to be inadvertently

penalized for enrolling in treatment
Be aware that clients may be more focused

on ―beating the case‖ than on recovery
Sentencing Alternatives Copyright 2008-2012
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29. 10 Components

1. Drug courts integrate alcohol and drug treatment
services with justice system case processing.
2. Using a non-adversarial approach, prosecution
and defense counsel promote public safety while
protecting participants’ due process.
3. Eligible participants are identified early and
promptly placed in the drug court program.
4. Drug courts provide access to a continuum of co-
occurring disorders treatment.
5. Abstinence is monitored by drug testing.
Drug Courts Copyright 2008-2012
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30. 6. A coordinated strategy governs drug court
responses to participants’ compliance.
7. Ongoing judicial interaction with each drug court
participant is essential.
8. Monitoring and evaluating achievement of
program goals is necessary to gauge
effectiveness.
9. Continuing interdisciplinary education promotes
effective drug court
planning, implementation, and operations.
10.Forging partnerships among drug courts, public
agencies and community-based organizations
generates local support and enhances drug court
program effectiveness.
Drug Courts cont… Copyright 2008-2012
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31. TASC programs provide a bridge between

treatment providers and the CJ system
 Provide a range of services
◦ Screening and assessment
◦ Referral to community-based services
◦ Monitoring of treatment
◦ Case management
◦ Court liaison
Treatment Accountability for Safer
Communities (TASC) Copyright 2008-2012
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32. Brief (TIP 34)

Motivational (TIP 35)

Behavior contacts

Phased treatment

Substance abuse education

Detoxification

Day reporting

Drug testing

Interventions Copyright 2008-2012
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33. Criminal thinking assessment and

treatment (video feedback)
Coping skills training

Relapse prevention tools

Strengths building

Communication skills enhancement

Interventions cont… Copyright 2008-2012
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34. Vocational

◦ Job readiness assessment and preparation
◦ Liaison with employer
Literacy assessment and referral

Anger management training

HIV education/testing/counseling

Assistance in accessing public assistance

Self-help programs

Wrap Around Services Copyright 2008-2012
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35. Most treatment is involuntary

Scheduling constraints: treatment

or…something else
Gang affiliation

Confidentiality

Trauma

Hopelessness (esp. prisons)

Treatment Issues in Jails Copyright 2008-2012
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36. Therapeutic community

 Intensive outpatient
 Half-way houses
 Day reporting
Special Issues: Community
Supervision Copyright 2008-2012
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37. Mental health issues

Abuse history

HIV positive

Poorer employment histories

Child custody issues

Lower educational level

Special Issues: Women Copyright 2008-2012
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38. Many have spent most of their life in and out

of ―the system‖
Prison rules and mores are the norm

Developmental milestones (marriage, raising

children, career, education, etc.) are absent
leading to disculturation
Engage them by having them help others

Special Issues

◦ Increased health problems
◦ Slow response to directions
◦ Physical issues presenting as MH
◦ Lack of assertiveness allowing them to slip through
the cracks
Special Population: Elderly Copyright 2008-2012
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39. Persons in the CJ system have a unique set

of learned behaviors
Consider the drawbacks as well as the

benefits to giving up criminality
Work with the client

Set and consistently enforce clear boundaries

and rules
Identify biopsychosocial issues and their

influence on treatment and recovery
Ensure clients have a seamless transition into

the community
Summary Copyright 2008-2012
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