Co-Occurring Disorders in Criminal Justice Settings
Screening for Trauma in Criminal Justice Settings
Many women and men with co-occurring disorders in the justice system have a history of trauma. Trauma histories are often not detected or addressed.
Consider the following:
- Ninety-five percent of women and 89 percent of men entering jail diversion programs have experienced physical or sexual abuse.
- A study of women inmates of a maximum security prison found that they experienced physical and sexual abuse throughout their youth and adulthood.
- An individual can be retraumatized by services, supervision, and management policies that do not account for trauma.
Practitioners need to know a person's trauma history.
Traumatic experiences are associated with the development of substance using behavior. Detecting and addressing trauma can have beneficial effects for engaging and treating individuals with co-occurring disorders.
Trauma screening informs treatment planning.
Trauma screening helps agencies gain knowledge about an individual's exposure to trauma and any related symptoms (e.g., post-traumatic stress disorder—PTSD). This information can inform treatment planning and supervision.
The use of a standardized instrument may be more effective than taking an extensive history. Trauma screening and assessment instruments are designed to be delivered by a trained behavioral health practitioner in a safe environment. Screening should include a plan for responding to any needs that arise during the interview.
Screening instruments for trauma vary.
Screening tools vary on three factors: objective, specificity, and population of interest.
- Objective. The objective of a trauma instrument is to identify an individual's experiences with traumatic events, such as abuse, assault, or combat. For example, a PTSD screening tool is designed to determine the likelihood of the disorder. Some PTSD screening tools also have a broader focus on related disorders.
- Specificity. Screening instruments for trauma may vary in specificity. For trauma exposure, this means that some instruments gather in-depth information about specific events. Others focus on a single event or traumatic experiences in general. PTSD instruments may map to single or multiple traumatic experiences.
- Population. Some instruments have been designed for specific population groups, such as combat veterans. For example, the PTSD Checklist is available in three versions: civilian, military, and specific.
Remember these key points about screening for trauma.
- Practitioners need to know about the trauma histories of justice-involved people with co-occurring disorders.
- Trauma screening helps obtain knowledge about exposure and related symptoms, which can be addressed in treatment planning and delivery.
Resources and Links
Recognition of the significance and prevalence of trauma issues for individuals in the criminal justice system is growing, and systems are responding by becoming trauma-informed. In Trauma Services in Criminal Justice Settings: What, Why and How, Joan Gillece, Ph.D. presented information on what trauma is and how it can affect those involved in the criminal justice system. Flo Hepola, a mental health clinician, addressed the challenges to providing trauma services in the criminal justice setting and ways practitioners can address these challenges. The webinar concluded with a question-and-answer session with the presenters.
The VA National Center for PTSD web pages on assessment provide reviews of trauma exposure and post-traumatic stress disorder instruments. Separate assessment pages are directed to a general audience and to behavioral health practitioners.