In a recent webinar, Dr. Norm Hoffmann explains how screening and assessment work, why they matter and how jails and specialty courts can better support the people they serve. Dr. Hoffmann is a clinical psychologist who is a nationally and internationally recognized expert on assessment of mental health and substance use disorders and on the evaluation of behavioral health programs. He has led major research projects and has authored or co-authored more than 220 publications.
Individuals entering jails and specialty court programs often have a history of substance use. It is common for this population to also face mental health conditions, such as depression or PTSD. Many have co-occurring conditions and face both challenges at once. Because jail stays are often short and stressful, it is important to identify behavioral health conditions early and connect individuals to the right support. Accurate identification helps keep both staff and incarcerees safe, and makes it more likely each individual will succeed following release.
Dr. Hoffmann explains that screening and assessment are not the same thing, but are often confused. A screen is a quick check. It tells you who probably needs a closer look and who probably does not. As he says, “Screening is a probability guesstimate that you are likely to have a given condition.”
A screen is not a tool to base a big decision on — that’s the role of an assessment. An assessment is a comprehensive, structured interview. “A thorough assessment is really a key component of developing a defensible treatment plan,” Dr. Hoffmann explains.
“Screens are, in the medical field, things like mammograms and colonoscopies. But you wouldn't make a medical decision based on those alone in terms of treatment, you would want the assessment of the biopsy as the definitive determination. To an extent, the same thing applies in the behavioral health area.”
In this webinar, Dr. Hoffmann highlights the benefits and drawbacks of various instruments, with real-world examples. For this population, he recommends the UNCOPE screen for substance use.
UNCOPE is a short set of questions about unplanned use, neglected responsibilities, trying to cut down, objections from others and preoccupation with using. The items line up with core substance use disorder criteria.
The UNCOPE was tested and refined against full diagnostic interviews. Dr. Hoffmann shares that it “tends to give you about a 90 percent accuracy rate, give or take.” He explains that three or more “yes” answers put a person at risk for a serious or severe substance use disorder, though sites can adjust the cut-off based on how many false positives or false negatives they can accept.
For mental health, Dr. Hoffmann and his team developed simple two-item screens for PTSD and depression. If a person answers “yes” to both questions in a set, they are flagged as likely having that condition. These tools are not perfect, but they help staff quickly find people who may need more help.
In jails, who asks the screening questions can also make a difference. Dr. Hoffmann jokes that it may not surprise anyone that “recent arrestees tend to lie to cops.” If a sworn officer asks about drug use, some people will not answer honestly. Because of this, Dr. Hoffmann recommends screening be done by medical staff, mental health staff or trusted non-custody staff such as peer workers or volunteers.
Assessment tools
When someone screens positive, they should receive a full assessment. Dr. Hoffmann recommends a tool called the CAAPE-5, which is now available in an online format. The CAAPE-5 covers substance use and mental health conditions in detail and focuses on patterns in the last 12 months.
Dr. Hoffmann describes specific cases where the CAAPE-5 has been used in carceral settings. These case studies show very high rates of substance use disorders and many people with more than one mental health condition. In some counties, almost half of people in jail had multiple severe substance use disorders, illustrating the complex needs of jail populations.
The importance of connecting to community resources
Even when staff identify behavioral health needs, it can be hard to keep people connected to care after release. Dr. Hoffmann talks about a “funding gap” that often happens. A person may qualify for Medicaid or other coverage, but it can take weeks or months for that coverage to start.
Dr. Hoffmann suggests that county leaders consider a special fund to cover services during this gap. That way, jail staff and community providers can start working with individuals prior to their release and continue after release. He believes “it is important to get people connected to services before they leave the jail, because otherwise, there's this tendency to not follow through.” He emphasizes that connecting individuals to resources prior to release can offer them a level of comfort and familiarity with those services, and improve their likelihood of following through upon release.
How sheriffs and specialty courts can use this information
The data from good screening and assessments can help sheriffs and specialty courts make informed decisions. For example, when one sheriff saw how many people in his jail had severe substance use disorders, he used that data to secure funding for more officers. Because incarcerated individuals told him they had no place to go when they were released, he worked with a local faith-based organization to set up a shelter next to the jail. The county has also since set up a drug court to focus on people whose crimes were closely tied to substance use. The insights gained from accurate screening and assessments helped spark these changes.
Specialty courts can use tools like the UNCOPE and CAAPE-5 to understand who they are serving and to match people with the right level of care. Courts can also partner with jails and community providers to improve care coordination and reduce recidivism.
These insights can not only improve care and bridge the gap between corrections and community resources, they can also save money. “[Assessment data] enables you to take a look at where the county might want to focus to reduce its own costs,” Dr. Hoffmann explains. “Behavioral conditions matter. They impact public safety, they affect recidivism, they contribute to jail overcrowding, and they cost you money. And therein is where you can sometimes leverage some buy-in.”
Moving forward
Identification and management of behavioral health conditions in jails and specialty courts starts with simple steps. Use solid screening tools. Make sure the right people are asking the questions. Follow up with full assessments. Then connect people to care inside the facility and in the community.
As Dr. Hoffmann reminds us, these conditions affect safety, crowding and cost. With better screening, assessment and a continuum of care, justice systems can support recovery, improve public safety and use resources more wisely.
Want more practical tools for justice and behavioral health teams? Stay updated on upcoming webinars and access past recordings here: https://changecompanies.net/webinars
