Statistical Assessment of Residential Integrated Treatment Programs (2001 – 2004)


The program runs from October 1, 2001, until September 30, 2004.




Enhancing the Dual Diagnosis Services in Davidson County – Creating a Diversionary Program for Nonviolent Felonies


Janet Hobson


Foundations Associates
Executive Director Michael Cartwright

The Goal of The Project

To assist dual diagnosed nonviolent felony offenders with a transitional treatment program, the Davidson County Community Corrections Programme partnered with Foundations Associates. A residential treatment and support program was implemented to provide dual-diagnosed offenders mental health support and treatment. This approach takes advantage of drug court principles by providing many of the same benefits to a defendant as a traditional court and emphasizing long-term treatment and one-on-one support instead of aggressive retributive mental health measures. Intensive community supervision and intensive correctional services, paired with sanctions based on corrections supervision, form effective measures. As well as reducing crime and the criminal acts that accompany it, there were also objectives for improving sobriety and behavioral stability mental health.

Background and Implementation of The Project

A significant portion of the project’s implementation cost was spent on expanding residential services for felony offenders that would otherwise be incarcerated if they were not allowed participation in the program. Drug court programs in Davidson County offer drug treatment to nonviolent offenders. As the programmatic ingredients for the single-diagnosed model of care have existed for some time, this project has emphasized dismantling the barriers to the diversion of people who abuse substances or those suffering from mental health distress. This project provided an opportunity for the organization, through an increase in capacity of its only integrated residential program (mental wellness and addiction therapy), to help meet the unmet substance abuse and mental health treatment needs of Metropolitan Nashville residents. There was an alternative to institutional punishment available through drug courts that offered diversionary treatment to those who attended. The original objective of this project was the establishment of a drug rehabilitation facility that would follow similar principles to drug courts.

It was originally scheduled to be launched on March 11 2002. In truth, however, only three females and two males were furloughed from a law enforcement setting on March 26, 2002, for reasons of codes requirements and license requirements. The FA efforts brought in more female residents through its contacts with court personnel, lawyers, and public defenders. New court team members included a psychiatrist who specialized in addictions and mental health issues, and MH therapist, a dedicated case manager and a drug and alcohol counsellor. During the enhanced diversionary program or encounter, groups emphasized making personal changes and stating progress were replaced by the old conflict resolution groups.

As mental health of the clients move through the recovery process, it would be ideal if the information was collected and updated continuously and a new assessment being performed. In contrast, the mental health of the clients traverses the recovery process. Comprehensive assessments are very helpful in a treatment planning process, as discussed in other chapters. This chapter will strive to produce a reference that outlines the ideal way to assess and treat patients with COD. Professionals will be encouraged to look at this as a positive example. While the panel identifies that not every agency can conduct a thorough investigation right away and that not every provider can do so, the panel believes that everybody needs to make sure that the matter is handled properly. Therefore, this chapter discusses the initial researching and the need for primary and minimal COD assessments in the initial care plan.

When you assess someone, you can determine if that individual requires a particular treatment and plan their treatment accordingly.

A Primary Assessment Process Gives Information on An Individual’s Physical, Cognitive and Psychological Status.

  • Identification of defined diagnoses as well as associated impairments, demographic and historical data
  • There are a few general strengths as well as problem areas to consider.
  • Various treatment stages for mental health and substance abuse
  • The severity of COD determines the level of particular care.

There are the same concerns when conducting an initial assessment for legal or medical issues, regardless of whether medical or legal issues are involved. Several issues are involved in our treatment planning, and it is important to have appropriate protocols designed to highlight these. After designing a patient safety model for acute care given the limitations of a healthcare system, let us now turn our attentions to managing chronic conditions.

Brief Overview

  • Screening and Basic Assessment for COD
  • Screening
  • Basic Assessment
  • Treatment Planning
  • The Assessment Process
  • Assessment Step 1: Engage the Client
  • Assessment Step 2: Identify and Contact Collaterals (Family, Friends, Other Providers) To Gather Additional Information
  • Assessment Step 3: Screen for and Detect Co-Occurring Disorders
  • Assessment Step 4: Determine Quadrant and Locus of Responsibility
  • Assessment Step 5: Determine the Level of Care
  • Assessment Step 6: Determine Diagnosis
  • Assessment Step 7: Determine Disability and Functional Impairment
  • Assessment Step 8: Identify Strengths and Supports
  • Assessment Step 9: Identify Cultural and Linguistic Needs and Supports
  • Assessment Step 10: Identify Problem Domains
  • Assessment Step 11: Determine the Stage of Change
  • Assessment Step 12: Plan Treatment
  • Assessment Process Summary

Detection of Co-Occurring Disorders

This section aims to give you a brief overview of the steps of screening and also assessing candidates based on their COD status. Having the limited authority to prescribe or assess disorders makes it vital that counsellors know these limitations. Unlicensed providers are generally allowed to gather assessment information so long as they don’t suggest an opinion or conclusion about the patient’s condition. These findings will enable the client to receive the best mental health treatment, tailored for each of the clients, including addressing the underlying reasons for mental health and treating them accordingly.

Further, factors like screening design, privacy settings and trust between mental health of the clients and counsellors can affect the validity of screens and assessments. To assess substance abuse, substance dependency, mental health disorders, and co-occurring disorders, one needs to continue to employ a sensitive approach.

This document serves to give guidance to Counselor Section regarding what is expected of its assessment for COD and approaches, responsibilities, and methods involved with COD. We cannot detail the screeners and assessments we conducted or the cultural issues involved in these screenings in this TIP. Additional information on essential screening as well as assessment, refer to Evans and also Sullivan (2001), NIDA (1994), Allen and also Wilson (2003). A Task Force on Improving Cultural Capability in Substance Misuse Treatment is being developed at the Center for Substance Abuse Treatment to help prepare individuals and groups to understand sexual and gender-based abuse.

What to Ask and How to Answer for COD Assessment Questions

  • Assessing someone who has complex and specific characteristics is a great opportunity to learn about their needs. We require more tools for assessing risk than anything else since a sustained outcome needs to be obtainable.
  • Never assume that all people involved in a confrontation or disagreement have the appropriate time to contact each other, including their families. significant others, probation officers, Friends and individuals receiving treatment from those providers are also called to help facilitate the assessment procedure. Collaterals will be used in the following with references to multiple sources of the information.
  • To meet client needs, it is essential not to let preconceived notions about addiction hinder one. (For example, one must discuss the psychological situation to be aware).
  • A good likelihood ratio for detecting cooccurring disorders between a person with a co-occurring disorder and a person who has not been diagnosed is 80%. Let clients know that a diagnosis and also treatment of mental health can be a valid procedure until a careful re-evaluation is done.
  • Research some drugs to treat personality disorders as well as common mental health disorders. Understand how your state treats priority mental health of the clients and how you can support them in meeting those needs. Provides instruction on referring patients for the mental health services through a mental health counsellor or to work in partnership with the mental health provider.
  • Any cognitive impairment (COD) cannot be treated by a single treatment method. Through the assessment process, we will be assessing multiple variables will help determine which individuals are suitable for which treatments. Even though clients have varying levels of mental health, follow treatment/prescription recommendations, it is crucial to follow a particular treatment direction correctly.
  • Providers should be aware of how they are handling COD in context of broader healthcare. This will help you better decide what patients your program would be able to serve, and you will be able to make mental health of the clients more accessible to the other settings of treatment that may better serve them.
  • Whether to your client or yourself, it is OK to acknowledge that you don’t know. Then you can tell the client you’ll ask for help if you don’t understand, then you can tell them you will be working with mental health of the client to locate the answers. Please suggest one supervisor experienced in using COD who could be used as a resource to serve as resource for questions that might arise.
  • Work with clients is not only about giving relevant information, but it’s also about helping clients develop hope. During uncertain times, connect with the client, be empathic and hopeful, and contribute to the best treatment plan with him and his treatment team.


An assessment is an organized process for determining whether a client is at risk for co-occurring disorders. The screening for co-occurring disorders (COD) examines the signs of potential substance abuse and compulsive behavior in the client and possible effects to the mental health. A screening process does not require spotting potential problems or assessing their severity; rather, it determines if further assessment is required. The principles of counselling can be applied to screening procedures designed by counsellors. Nobody is legally or professionally obliged to conduct screenings.

Clients must be considered when assessing potential clients to conduct a thorough assessment mental health. The screening process should define precisely what thresholds must be met to score positive or negative on various possible items. A screening protocol should also state what should happen if the client scores positively by providing details of subsequent assessments to be completed by the appropriate staff members mental health.

Finally, in assessing substance abuse counsellors, what do you need to do to get screened? The counsellor’s training must include the detection of COD in client’s. Screenings typically involve the counsellor asking questions, scoring the results, and moving along based on client mental health results. Each counsellor and clinician at a treatment center should be familiar with CODs and assess and recommend them using protocols. Among the mental health screening forms offered is the Mental Health Screening Form-III (Carroll and McGinley 2001). In the treatment of the substance abuse, it is common to complete a short instrument such as the instrument shown here. It is not intended or recommended to diagnose a person’s psychological problems. Even though consensus panel members have concluded that the instrument is useful, it is known that its effectiveness has been low [Carroll and McGinley 2001].

Basic Assessment

There are several differences between screening and assessment. Among them is the purpose of the assessment: to collect information about client to provide him with better treatment options.

  • The screening process helps to identify whether there is a problem.
  • Identifying a problem results in specific recommendations for solving it by finding its significance and evaluating its implications.

In a basic assessment, the counsellor gets to know the client`s mental health better, and he or she describes issues/problems, COD diagnoses, strengths and weaknesses that are crucial to the client’s readiness for the change. During the clinical evaluation of a client, tests and exercises are often used, and detailed interviews about the client’s behavior and self-perception. A psychiatrist or clinical psychologist establishes evidence of COD when a patient is referred to one of these healthcare practitioners. COD assessments must be repeated regularly to get a comprehensive picture of the client’s progress in relation to mental health.

The Information Collected by The Intake Forms Includes:

  1. History: Family characteristics, trauma history, criminal background (criminally or otherwise), relationship status, health and education, financial situation, employment and education.
  2. Drug Usage: age during the first use, basic drugs (including alcohol), the pattern of the substance abuse, and treatment episodes
  3. Health Problems: Symptoms and mental health states at home and work, history of the mental health/illness, medications and adherence to medications

You can also use various imaging metrics, like the (URICA), the (ASI), Mental health Screening Form III, and the (SDS). Each, as seen in Appendix G, Appendix H, and Appendix E, has information on experimental setups. Most counsellors need to comprehend this information logically before designing a treatment plan to diagnose mental health disorders accurately. Below, you’ll see an example of how that works.

The Role of Assessment Tools

A Frequent Question Asked by Clinicians Is:

• What is the best (most valuable) assessment tool for COD?

The Answer is:

No one assessment tool is universally accepted as the gold standard for COD. Traditional clinical tools are mainly used to analyze specific issues, such as the Beck Depression Inventory (Beck and Steer 1987), comprised of 21 questions about how depressed a person is and other symptoms similar to them. All counsellors should be able to utilize various tools to collect comprehensive information about their client`s mental health. Generalized tests of this nature measure various addiction domains, including eating disorders, drinking disorders, and weight-control issues. It (McLellan et al. 1992) is a model of this type of tool (McLellan et al. 1992). Using an assessment tool like ASI, counsellors can become adept at collecting the necessary information by continually performing the assessment.

Additionally, a counsellor will find it easier to find ways to reflect on clients the differences and similarities they have with them. An examination designed to collect information about a person’s mental health can aid in diagnosing a person’s mental health conditions. In this study, we seek to determine whether Haemophilus infections are widespread in the general population.

When you pay attention to previous episodes of the substance abuse (and abstinence), a person’s history of the substance abuse can show clear signs, impairments, diagnoses, and treatment in terms of their mental health. We can learn more about mental health problems that persist despite abstinence for a month by searching for the patterns of mental health problems that persist throughout abstinence. For abstinence periods of one month or longer, a counsellor can discuss mental health and substance abuse options with the person. If medication or alcohol still leads to symptoms of mental health (even suicidality and hallucinations), here one may conclude that substance abuse is to blame. One must abstain from drugs more often than not to remain in a stable, sober state.

Counsellors can also inquire about what sort of progress the client has been making with their mental health. When the circumstances of the client worsen, what happens? How can I get a better understanding of what has happened so far? Could you please give me a more detailed explanation? When a client is experiencing a lot mental health distress, how does her or his well-being generally manifest itself? The client and the clinician should explore whether substance use can trigger psychiatric symptoms, in addition to understanding the specific impact of substance use on mental health signs. Mental health professionals ought to assist the patient in understanding their issues better. Many individuals in recovery for cocaine addiction already have an established diagnosis when they enroll rehabilitation treatment.

Treatment Planning

An individual’s mental health treatment plan will be based on the results of a comprehensive assessment. These may seem pretty complex because they depend on the most current discoveries within each domain, resulting in the best treatment plans and therapeutic interventions. A second fundamental principle follows from this: A person with COD should not be referred to anyone specific treatment system or program. Various factors need to be considered when deciding on an appropriate mental health treatment plan.