Screening of individuals during intake is key to jail safety. It is part of a larger information-gathering process that begins with the individual’s initial contact with the justice system. It is vitally important for jail leaders and staff to have information on an individual’s risk for suicide, mental health conditions or needs, substance use, and potential for substance withdrawal as part of the intake process. Early detection or identification of each individual’s risks and needs enable critical interventions to occur sooner and often lead to better outcomes for individuals who enter the jail.
What is Screening?
Screening is generally a one-time event conducted at intake for the quick and early identification of individuals at risk of death or harm due to physical health, mental health, substance use, withdrawal from alcohol or drugs, or suicide. Screening instruments are usually brief, using simple “yes/no” questions, and can be administered by health care professionals or trained custody staff. Screening results do not result in an official diagnosis of a specific condition(s) or disorder(s) but are designed to indicate a need for further evaluation or preliminary intervention.
Who should be screened?
Universal screening is key to effective jail management and reducing the risk of death or harm in custody. This means that everyone being admitted into the facility, regardless of length of stay or conviction status, is screened for physical health conditions, infectious disease(s), mental health conditions, risk for suicide, and substance use disorders. The screening process identifies people entering the jail who may be at risk of death or harm and are likely to require a full clinical assessment or additional services.
What does screening determine?
Screening determines if an individual is at risk of death or harm due to physical health, mental health, substance use, withdrawal from alcohol or drugs, or suicide. To evaluate risk effectively and accurately within the jail, people being booked into jails should be screened for:
Where should screening occur?
Screening should be done at intake, during booking, or soon after. Many older jails were not built to provide intake and release functions in privacy; however, this does not mean that improvements cannot be made. The collection of potentially sensitive personal information should be conducted in a semi-private area where individuals feel more comfortable discussing such sensitive or personal matters. Use of a private or semi-private setting is likely to increase the accuracy and validity of the information needed to inform critical operational decisions regarding the individual’s medical, housing, and programming needs.
Who should conduct screening?
A staff person or health care provider who has been trained to administer the screening instrument should conduct the screening. In many jails, custodial, medical, mental health, and programming staff are all involved in screening and assessing individuals in some way. All staff conducting screenings should participate in training on the screening instrument and protocol. The level and nature of training on screening should be directly related to the screening and/or assessment instrument being used.
When should screening be conducted?
Screening should occur at intake, or soon after to identify an individual’s physical and mental health conditions and needs, substance use history, risk of drug or alcohol withdrawal, and suicide risk.
Why is screening important?
Screening is the first opportunity to capture critical, actionable information about a person’s risk for death or harm. Information obtained during the screening process determines if a more comprehensive clinical assessment is warranted for each person in custody. Screening results also inform jail housing classification, programs, and/or interventions. Effective screening practices help jail administrators understand who is entering the jail and how to utilize existing resources best to mitigate the risk of death or harm. Screening at intake is meant to fulfill five primary purposes:
How should my agency select a screening instrument?
Questions to consider when selecting a screening instrument include:
Select Screening Instruments
The screening instruments identified below are available at no-cost to agencies and require minimal training to effectively implement.
The following screening instruments to identify substance use have been validated in a correctional setting. These instruments can be used during the intake process to help identify immediate risk and needs.
Drug Abuse Screening Test-10 (DAST-10): The DAST-10 is a 10-item scale designed to screen for potential drug use. The instrument is available from the National Institute on Drug Abuse (NIDA).
Texas Christian University (TCU) Drug Screen V: The TCU Drug Screen V is a 17-item scale that screens for mild to severe substance use disorder. The TCU Drug Screen V also has an opioid supplement to identify the needs of people with opioid use disorders. The instrument is available from the Texas Christian University.
The following screening instruments can be used to identify signs and symptoms of substance use withdrawal in a community setting and can be used in a correctional setting. These instruments can be used during the intake process to help identify immediate risk and needs.
Clinical Opiate Withdrawal Scale (COWS): The COWS is an 11-item scale used to identify common signs and symptoms of opiate withdrawal and monitor these symptoms over time. The instrument is available from the National Institute on Drug Abuse (NIDA).
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CTWA-Ar): The CTWA-AR is a 10-item scale used to measure alcohol withdrawal symptoms. The instrument is available from the University of Maryland School of Medicine.
Clinical Institute Withdrawal Assessment Benzodiazepines (CIWA-B): The CIWA-B is a 22-item scale measuring benzodiazepine withdrawal symptoms. The instrument is available from the Center for Alcohol and Other Drug Training and Workforce Development.
Screening instruments to identify suicide risks that have been validated in the community can be used in correctional settings. These instruments can be used during the intake process to help identify immediate risk and needs as well as certain situations during a person’s period of incarceration, such as placement in restrictive housing/segregation, following a court hearing, proximate to a transfer, or a change in security status. The following list includes some of the screening tools that have been validated on community populations:
Columbia Suicide Severity Rating Scale(C-SSRS): Three versions are available. The “Lifetime/Recent” version supports inquiry into an individual’s lifetime history of suicidal ideation and behavior as well as any recent suicidal ideation and/or behavior. The “Since Last Visit” version of the C-SSRS screens for suicidal ideation and behavior since the individual’s last visit. The “Screener” version is a shortened form of the full version. The instrument is available from Columbia University.
Suicide Behaviors Questionnaire–Revised (SBQ-R): The SBQ-R is a 4-item questionnaire that includes questions about suicidality over the lifespan and future risk. The instrument is available from the University of Nebraska.
Patient Health Questionnaire – 9 (PHQ-9): The PHQ-9 is a 9-item questionnaire used most often in primary care settings that has been validated in identifying high-risk individuals. The instrument is available from the American Psychological Association.
The following screening instrument to identify mental health conditions has been validated in a correctional setting. This instrument can be used during the intake process to help identify immediate risk and needs. Instrument is available from the American Psychological Association.
Brief Jail and Mental Health Screen (BJMHS): The BJMHS is an 8-item screen that takes approximately 2-3 minutes to administer. It includes questions about psychiatric treatment history. The BJMHS has been validated in criminal justice settings. The instrument is available from the Policy Research Associates.
Introductory statement on assessment homepage
Assessment builds on information collected during the screening process and contributes to jail leaders’ and staff’s ability to maintain the safety and well-being of those in their custody, staff, and visitors. Assessment is more comprehensive than screening and allows the jail to examine the risks and needs identified during the screening more deeply to determine the appropriate course of action for each person. As with screening, assessment is a critical process for jail leaders that often leads to better outcomes for individuals who enter the jail.
What is assessment?
Assessment is an in-depth process involving a comprehensive examination conducted by a qualified mental health professional. Assessment is not a one-time event, but rather a process that should continue throughout the at-risk person’s period of incarceration.
Who should be assessed?
An assessment should be performed on individuals who are determined to be at risk based on the results of their initial screening.
What does an assessment determine?
A comprehensive assessment determines which treatment(s), 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.
Where should an assessment occur?
The assessment should occur within a private area.
When should an assessment be done?
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:
Why are assessments important?
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:
How is a valid and reliable assessment process implemented?
The following steps should be taken to ensure a valid and reliable system is in place for performing assessments:
Who should conduct assessments?
Assessment instruments take significantly longer to administer than do 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. 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 screening and assessment 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 inter-rater reliability checks conducted by trained supervisors to maintain standards that ensure instrument outcomes are the same or similar regardless of who performs the assessment.