Co-Occurring Disorders in Criminal Justice Settings

Screening for Criminal Risk

Justice-involved people are at risk for continued criminal activity. Many risk factors are the same for people with or without co-occurring disorders. Risk factors include:

• Adult criminal history
• Juvenile delinquency
• Family strife
• Unstable housing

Substance abuse and antisocial personality disorder have also been identified as risk factors for continued criminal activity.

Screening informs behavioral health services.

Screening for criminal risk and need informs the planning and delivery process for behavioral health services and criminal justice supervision. Screening provides behavioral health practitioners and criminal justice professionals with information they can use when working with individuals on behavioral health and criminal risk reduction goals. When working with justice-involved people with co-occurring disorders, services focused on criminogenic needs are designed to be integrated with behavioral health services.

Screening for criminal risk is driven by three principles:

The risk principle means that the level of service is matched to an individual's likelihood of committing a crime. Based on the risk principle, a person who is at high risk for criminal activity receives more resources targeting criminogenic needs than a person who is at low risk. In part, this is a resource allocation strategy. Research has also shown that low-risk individuals do not need high levels of risk-reduction services. Moreover, when low-risk individuals receive a high level of service, it may actually increase criminal risk.

The need principle helps determine how to target interventions so as to reduce criminal risk. Screening instruments for criminal risk are centered on the following eight major risk factors:

• Antisocial behavior, such as criminal activity, juvenile delinquency.
• Antisocial personality pattern, such as low self control, aggression.
• Antisocial cognition, such as attitudes, values, or identity supportive of crime.
• Antisocial associates, such as friends or family members supportive of crime.
• Family/marital factors, such as domestic conflict and lack of monitoring.
• School/work factors, such as low school/work performance/satisfaction.
• Leisure/recreation factors, such as low involvement or satisfaction with prosocial activities.
• Substance abuse, such as abuse alcohol or drugs and social support for abuse.

The responsivity principle means matching the treatment intervention to an individual's learning style and ability. It also means providing supports for new skills. Cognitive behavioral treatment targeted to an individual's criminogenic needs is one of the main strategies that behavioral health and criminal justice agencies use to achieve risk reduction.

Screening instruments for criminal risk

Criminal risk screening instruments have evolved over the past decade. Current instruments attend to the principles of risk, need, and responsivity. One prominent instrument is the Level of Service Inventory-Revised . Another set of instruments combine the principles with follow-up supports for clinicians. This category includes Correctional Offender Management Profiling for Alternative Sanctions  and the Level of Service/Case Management Inventory .

Remember these key points about screening for criminal risk.

• Risk factors for criminal activity among justice-involved people with co-occurring disorders are often the same as for people without co-occurring disorders.
• Criminal risk screening is driven by the principles of risk, need, and responsivity.
• Services focused on criminogenic needs are designed to be integrated with behavioral health services.

Resources and Links

• Improving Outcomes for People with Mental Illnesses under Community Corrections Supervision: A Guide to Research-Informed Policy and Practice

  This guide reviews recent research on community corrections supervision for people with mental illnesses and translates the findings to help officials develop effective interventions. This first-of-its-kind guide helps program planners and policymakers apply research on promising practices to improve outcomes for people with mental illnesses under community corrections supervision.

• Individuals with Mental Illnesses in the Criminal Justice System: Addressing Both Criminogenic Risks and Mental Health Needs

  This webinar provides an overview of how criminogenic risk factors contribute to the involvement of people with co-occurring substance disorders in the criminal justice system. Dr. Skeem discusses the need to develop approaches that take into account individuals' criminogenic risk factors and their functional impairments. An intervention model that does both is presented. The webinar concludes with a question-and-answer period.

• Sensitizing Providers to the Effects of Incarceration on Treatment and Risk Management (SPECTRM)

  This article describes Sensitizing Providers to the Effects of Correctional Incarceration on Treatment and Risk Management (SPECTRM), an approach to client engagement that is based on an appreciation of the "culture of incarceration" and its attendant normative behaviors and beliefs.

• Targeting Criminal Recidivism in Justice-Involved People with Mental Illness: Structured Clinical Approaches

  This brief reviews structured clinical interventions to target criminal behavior for justice-involved people with mental disorders, with a focus on cognitive behavioral treatment.