Susan Sturges, MA, MPA
Mental Health Coordinator
Brooklyn Treatment Court

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Full-time problem-solving court
 Adult Drug Court
 DUI Court
 Veterans Court
 Co-Occurring Court
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Currently 300+ active cases
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78% graduation rate
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Estimated 20% of participants have current mental health diagnosis

Specialized screening and assessment:
 Post Traumatic
Checklist (PCL)
 Beck Depression
Inventory
 Level of Service
Inventory Revised
 Trauma Symptom
Inventory – 2
 Comprehensive
Psychiatric Evaluation
Specialized services:
 Assigned to a dedicated case manager
 Receive treatment for both substance abuse and mental health needs
 Peer support

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High rates of trauma among justice involved individuals.
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Underreported by trauma survivors.
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Trauma-related symptoms often not evaluated and go unrecognized and untreated.
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Symptoms of trauma can be mistaken for symptoms of psychotic or affective disorders
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Allows for the development of traumainformed responses:
 Increase safety
 Reduce recidivism
 Promote recovery

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Screening is brief and focused on specific traumatic events.
 Example: Post Traumatic Checklist (PCL)
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Assessment is an in-depth exploration of the nature and severity of the traumatic events, the consequences of those events, and current trauma-related symptoms.
 Example: Trauma Symptom Inventory-2 (TSI-2 )

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It is recommended that all
participants be screened for trauma as part of the initial intake or assessment process:
 To determine appropriate follow-up and referral
 To identify imminent danger requiring urgent response
 To identify need for trauma-specific services

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Maximize participant choice and control as much as possible
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Explain directly and clearly the reasons for the screen and offer explicit options of not answering questions
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Give option of taking breaks
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Give option of Self-administering the questionnaire
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De-brief with a discussion of its implications for service planning, and for any necessary immediate intervention.

Assessment:
Trauma Symptom Inventory
(TSI-2)
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136 item self-report measure
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Assesses impact of traumatic events over the past six months
– Rated 0 (never) to 3 (often)
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Relevant for various types of trauma
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Scoring
– Four overall factors
– 12 clinical scales
– 2 validity scales

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Self-Disturbance
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Post-Traumatic Stress
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Externalization
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Somatization

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Anxious Arousal
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Depression
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Anger
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Intrusive Experience
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Defensive Avoidance
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Dissociation
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Somatic Preoccupations
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Sexual Disturbance
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Suicidality
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Insecure Attachment
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Impaired Self-Reference
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Tension-Reduction
Behavior

Clinical Cutoffs
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Raw scores are converted to t-scores
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T-scores have a mean of
50 and a standard deviation of 10
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T-score of 65+ indicates further assessment is recommended
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6.7% of respondents will score 65+ (1.5 s.d. above the mean)
Percentile Scores
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Percentiles will range from 0-100%
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No published clinical cutoff

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Data were collected from 22 drug court participants
 15 (68.2%) were women
 Average age: 42.8
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Mental health diagnoses included:
 PTSD
 Depression
 Bi-polar Disorder
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Substances used included:
 Crack (36.4%)
 Heroin (27.3%)
 Polysubstance (9%)

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19/22 (86.4%) of participants had a t-score of 65+ on at least one TSI scale
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On average, participants had clinically significant scores on 2.13 scales (range 0-9)
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The most common scales with clinically significant scores were:
– Defensive Avoidance (12 participants)
– Intrusive Experience (8 participants)
– Tension-Reduction Behavior (6 participants)

100
80
60
40
20
0
AA
DEP
ANG
IE
DA
DIS
SOM
SXD
SUI
ISA
ISR
TRB

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8 participants had scores on the validity scale that were above the cutoff (t-score
65+)
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Using the 90 th percentile as the cutoff, 9 participants had scores on the validity scale that were above the cutoff
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The tendency to exaggerate symptoms must be taken into account when using the TSI-2

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Specialized treatment planning
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Trauma-informed responses:
 Orientation
 Waiting-room policy
 Toxicology screening process
 Sanctions/Incentives
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Peer Support
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Treatment