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Adults with Behavioral Health Needs under Correctional Supervision
It is important to note that the second sorting could have just as easily been made to determine mental health needs next. The framework places determining substance abuse needs as the second sort based on several factors: (1) substance abuse is one of the eight core criminogenic risk factors, and mental illness is not (because the entire framework is oriented toward reducing reoffending and reincarceration through better behavioral health interventions, it made sense to first sort for criminogenic risk); (2) substance use disorders are more prevalent than nonaddictive behavioral health disorders in corrections populations; and (3) sorting in this order parallels some of the labeling of the quadrants in the model created by NASHMPD and NASADAD (see page 30) and reveals how some of the foundations for this framework are assimilated.* This criminogenic risk/behavioral health needs framework creates groupings that can facilitate tailored interventions to adults under correctional control and supervision. Consistent with the risk principle, it can serve as a roadmap to effectively
Defining the Groupings The way in which system managers determine the categories to group individuals depends on what measures are used, the distribution of individuals with low and medium/high risk and need in the population being assessed, and the cut-off scores used for assignment. One challenge will be to operationalize the definitions for low, medium, and high risk and need and then establish benchmarks determined by valid screening and assessment measures. For example, administrators will need to determine what scores from assessment tests qualify someone as “low risk” and what scores place them in another category. If the resulting groupings do not adequately differentiate the population (for example, 95 percent qualify as “high risk”), then changes to cut-off scores may need to be made to further distinguish which individuals have the greatest risk and need factors. Administrators will then need to be mindful of their supervision and treatment resources when prioritizing subgroups and individuals within subgroups. That is, if assessments determine that more individuals fall within a high-risk category with intensive supervision needs than there are available slots, a narrower slice of the subgroup may be addressed until capacity is increased. Alternatively, if the assessment process identifies fewer individuals with high risk/need than anticipated, the group selected for supervision or services can be extended into moderate risk/need levels. It is important to recognize that individuals at various stages of rehabilitation and recovery may move between these risk/need categories throughout their lives. Periodic reassessments and noted changes in impairment or risk level may require changes in how officials prioritize supervision and treatment services.
*In this framework, when the substance abuse and mental health needs are isolated, subgroups 1–4 correspond to the NASMHPD/NASADAD quadrants (and repeat for subgroups 5–8).