A comprehensive assessment determines which treatments, programs, and/or services may be necessary and appropriate to reduce the risk of death or harm. The assessment is done to identify specific condition(s) that require attention from jail leaders and staff.

For individuals whose screening results indicate that an assessment(s) is necessary, the assessment(s) should be conducted as soon as possible after the intake process. Assessments may also occur at any point during the person’s incarceration based on their current needs.

Reassessment occurs based on individual circumstances. Reasons to reassess a person in custody include the following:

• Improvement or deterioration of behavior.
• A crisis in the person's life.
• A medical or mental health emergency.
• Receipt of court documents and commitment orders.
• An individual's request for reassessment.
• An officer's request for a reassessment based on observed changes in behavior or information that has been reported to the office.

Assessments inform decisions about programming, housing, and treatment in jail and transitional care upon release. Assessments are used to identify and address concerns related to a person's physical health, mental health, substance use, or risk of suicide that jeopardize their safety and well-being. Assessments may also determine if additional, more specialized assessments are required.

Three key reasons to perform an assessment include the following:

• To better understand the risk and need(s) profile of the people that comprise the jail's population.
• To allow for informed decision making on efficient and cost-effective strategies to address individuals’ physical health, mental health, and substance use needs during incarceration and upon release.
• To identify the level of support, responsibility, and training that staff and contract vendors need to effectively and safely work with incarcerated individuals before and after their release.

The following steps should be taken to ensure a valid and reliable system is in place for performing assessments:

• Develop or select assessment instrument(s) that have been or will be validated for use with jail populations.
• Create and implement protocols to apply the assessment instruments to selected incarcerated individuals.
• Train staff to administer the assessment instruments.
• Identify the subset of incarcerated people whose initial screening results indicate the need for a formal assessment.
• Create and implement protocols to apply assessment instrument(s) to incarcerated people identified as appropriate for assessment(s).

Assessment instruments take significantly longer to administer than screening instruments. A common mistake is to compel the incarcerated person to complete an assessment on paper alone with little or no assistance from the staff. Rather, more reliable, accurate information is gathered through an interactive assessment process undertaken by trained and committed staff who are active listeners. The process should identify staff who have the interest and capability to complete these assessment instruments as they were designed must be identified.

Measures and methods should be implemented by jail leaders to ensure that screenings and assessments are completed as warranted, and that quality information is obtained via these processes. Such quality assurance practices range from simple process measures to more comprehensive quality and outcome evaluations. For example, a simple evaluation of daily process reports should ensure that all people entering the jail receive the appropriate screening. At the same time, more comprehensive practices should include interrater reliability checks conducted by trained supervisors to maintain standards that ensure instrument outcomes are the same or similar regardless of who performs the assessment.